Objective: Objective: To assess the effect of at-home adaptive deep brain stimulation (aDBS) on symptoms and treatment-associated side-effects in one patient with Parkinson’s disease (PD), using an individualized neural signal biomarker, compared to continuous DBS (cDBS).

Background: Background: DBS is an effective therapeutic option for PD. However, the gold-standard, cDBS, can be associated with residual motor fluctuations, limiting the therapeutic window. In-clinic and brief at-home algorithms adapting stimulation in response to invasive neural biomarkers of PD symptoms previously showed better clinical effects compared to cDBS [1-3]. A tremor-specific adaptive algorithm has not yet been tested at home.

Method: Methods: We developed a unilateral aDBS algorithm for one patient with PD (m, 74yrs), who experienced bothersome motor fluctuations with cDBS on the right side. A movement disorders neurologist determined cDBS and aDBS stimulation amplitudes. We obtained 75h of at-home neural recordings from the left subthalamic nucleus off and on stimulation using a sensing-enabled DBS device in combination with wearable sensors for symptom monitoring. For biomarker identification, we computed partial correlations between time-resolved power of the neural signal and symptom scores (tremor, dyskinesia) controlling for stimulation amplitude. We compared aDBS to the best clinical cDBS setting in a single blind, randomized manner. Stimulation conditions were applied for 24h at the patient’s home, during which we obtained motor diaries, wearable data, and quality of life scores (QOL, EQ-5D).

Results: Results: 13hz oscillations correlated positively with  tremor and negatively with dyskinesia, while controlling for stimulation amplitude. The 11-15hz band was subsequently used as neural biomarker for aDBS. Motor diaries indicated that the patient experienced troublesome tremor and dyskinesia during 37% and 78% of awake hours, respectively, on cDBS (at times simultaneously). The aDBS algorithm was associated with a reduction of all troublesome symptoms to 0% of awake hours, also reflected in wearable data. QOL increased from 65% on cDBS to 75% on aDBS. Total electrical energy delivered during aDBS (52.3μJ) was comparable to cDBS (48.8μJ).

Conclusion: Conclusions: Data from one patient indicate that patient-tailored aDBS was effective in an at-home environment to manage tremor and dyskinesia and increases QOL.

References: [1] Little et al. Annals of Neurology, 2013
[2] Arlotti, Neurology, 2018
[3] R. Gilron et al., Nat. Biotechnol., 2021.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/at-home-prolonged-adaptive-deep-brain-stimulation-improves-symptoms-and-reduces-side-effects-in-parkinsons-disease/