Deep brain stimulation (DBS) involves implanting an electrode in a specific area of the brain, and then adjusting stimulation settings to a level that alleviates symptoms without causing side effects. While DBS has been shown effective for treating Parkinson’s, there can be disparity in outcomes among implanted patients due to varied postoperative management, particularly concerning DBS programming optimization. Variability may be due to programmer training and experience and time required to determine an optimal set of DBS parameters. Programmers can adjust several types of settings including the contact, polarity, frequency, pulse width, and amplitude of stimulation. This creates a tremendous amount of possible combinations that must be evaluated over multiple types of motor symptoms in a limited time frame during an office visit.
Programming deep brain stimulation (DBS) settings for Parkinson’s disease can be challenging for clinicians. Kinesia technology provides automated tools to measure tremor, bradykinesia, and dyskinesia, which can assist with programming DBS. Kinesia technology can provide tuning maps during in clinic programming sessions to help visualize symptom response to DBS settings. Kinesia telemedicine solutions allow clinicians to screen patients before DBS surgery and follow patient symptoms at home after programming.
Objective DBS Programming
Kinesia algorithms have been shown to identify stimulation parameters that improve symptomatic benefits and/or reduce battery usage better than standard clinician programming. https://pubmed.ncbi.nlm.nih.gov/25703990/
Additionally, computer-guided programming using Kinesia has been shown to improve Parkinson’s symptoms comparable to clinician programming. https://pubmed.ncbi.nlm.nih.gov/26621764/
Patient Screening Prior To DBS
It can be challenging for clinicians to determine when a patient is appropriate for DBS therapy. One indication can be when medication is no longer effective and the patient experiences severe motor fluctuations during the day. KinesiaU is designed to capture motor fluctuations and report symptom severity of tremor, bradykinesia, and dyskinesias from patients at home. These reports may be useful as additional information to help clinicians determine if a patient is ready for DBS as indicated by daily motor fluctuations. In a clinical study, the advanced therapy referral rate was significantly higher for patients when a clinician had access to Kinesia remote monitoring reports compared to standard care alone (https://pubmed.ncbi.nlm.nih.gov/27392872/)
DBS Programming Follow-Up
Once a patient has DBS therapy, stimulation settings may be adjusted in outpatient programming sessions. While some motor symptoms such as tremor respond quickly to stimulation setting changes, others such as bradykinesia may take longer to response. KinesiaU can provide a telemedicine solution to track motor symptom response to DBS settings for days after the patient leaves the programming session.