title: Computer-Guided Deep Brain Stimulation Programming for Parkinson's Disease.
abstract: OBJECTIVE
  Pilot study to evaluate computer-guided deep brain stimulation (DBS) programming designed to optimize stimulation settings using objective motion sensor-based motor assessments.
  
  
  METHODS
  Seven subjects (five males; 54-71 years) with Parkinson's disease (PD) and recently implanted DBS systems participated in this pilot study. Within two months of lead implantation, the subject returned to the clinic to undergo computer-guided programming and parameter selection. A motion sensor was placed on the index finger of the more affected hand. Software guided a monopolar survey during which monopolar stimulation on each contact was iteratively increased followed by an automated assessment of tremor and bradykinesia. After completing assessments at each setting, a software algorithm determined stimulation settings designed to minimize symptom severities, side effects, and battery usage.
  
  
  RESULTS
  Optimal DBS settings were chosen based on average severity of motor symptoms measured by the motion sensor. Settings chosen by the software algorithm identified a therapeutic window and improved tremor and bradykinesia by an average of 35.7% compared with baseline in the "off" state (p < 0.01).
  
  
  CONCLUSIONS
  Motion sensor-based computer-guided DBS programming identified stimulation parameters that significantly improved tremor and bradykinesia with minimal clinician involvement. Automated motion sensor-based mapping is worthy of further investigation and may one day serve to extend programming to populations without access to specialized DBS centers.
authors.affiliation: Great Lakes NeuroTechnologies Inc., Cleveland, OH, USA.
authors.forename: Dustin A
authors.initials: DA
authors.lastname: Heldman
authors.affiliation: Great Lakes NeuroTechnologies Inc., Cleveland, OH, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Pulliam
authors.affiliation: University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Enrique
authors.initials: E
authors.lastname: Urrea Mendoza
authors.affiliation: University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Gartner
authors.affiliation: Great Lakes NeuroTechnologies Inc., Cleveland, OH, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Giuffrida
authors.affiliation: Greenville Neuromodulation Center, Greenville, PA, USA.
authors.forename: Erwin B
authors.initials: EB
authors.lastname: Montgomery
authors.affiliation: University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Alberto J
authors.initials: AJ
authors.lastname: Espay
authors.affiliation: University of Cincinnati, Cincinnati, OH, USA.|Greenville Health System, University of South Carolina School of Medicine-Greenville, Greenville, SC, USA.
authors.forename: Fredy J
authors.initials: FJ
authors.lastname: Revilla
mesh_terms: D000368:Aged; D000465:Algorithms; D003201:Computers; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000628:therapy*; D010865:Pilot Projects; D012984:Software
keywords: Deep brain stimulation (DBS); Parkinson's disease; motion sensing; objective measures; programming strategies