Clinical efficacy of remote programming after deep brain stimulation for Parkinson's disease based on microelectrode recording results
Objective To compare the efficacy of postoperative remote programming and conventional outpatient programming of deep brain stimulation(DBS)for Parkinson's disease(PD),and to explore the guiding role of microelectrode recording(MER)in selecting contacts for postoperative programming.Methods This study was a retrospective cohort study.A total of 122 PD patients who underwent bilateral subthalamic nucleus(STN)-DBS treatment at the Neurosurgery Department of the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from February 2019 to December 2021 were enrolled.The DBS devices was turned on at 1 month after surgery and follow-up was performed at 1 year after the start-up of device.According to the postoperative programming method and the selection strategy of stimulation contact in initial programming,the patients were divided into outpatient conventional programming group(39 cases),remote conventional programming group(41 cases)and MER-guided remote programming group(42 cases).The surgical outcomes of the three groups of patients were compared.Pre-baseline data,improvement rate of the sum of tremor and bradykinesia scores in the Unified PD Rating Scale Part Ⅲ(UPDRS-Ⅲ)during the 1-year med-off period after surgery,daily levodopa equivalent dose(LEDD)reduction rate,times of programming adjustments during the 1 year after start-up,the percentage of patients requiring programming adjustment at follow-up,the time taken in initial programming after device start-up,and the number of discomforts experienced during the start-up period.Results There were no significant differences in age,gender,course of disease,Hoehn-Yahr stage,preoperative LEDD,preoperative"med-off"UPDRS-Ⅲ score,sum scores of preoperative"med-off"UPDRS-Ⅲ tremor and bradykinesia,or improvement rates of preoperative levodopa challenge test(LCT)among the three groups(all P＞0.05).At the follow-up of 1 year after stimulation,there was no significant difference in the improvement rate of the sum scores of"med-off"UPDRS-Ⅲ tremor and bradykinesia in the three groups,while the reduction rates of LEDD[median(Q1,Q3)]in the remote conventional programming group[46.7％(30％,50％)]and MER-guided remote programming group[46.6％(30％,60％)]were both significantly higher than that in the outpatient conventional programming group[33.3％(0％,50％),H=6.05,P=0.049].The times of programming adjustments in the remote conventional programming group and MER-guided remote programming group was more than that in the outpatient conventional programming group[M(Q1,Q3):5(4,7),6(5,7)and 6(5,8)respectively,H=8.35,P=0.015],while the patients'programming requirements during follow-up were significantly less than those in the outpatient conventional programming group[percentage:31.7％(13/41),31.0％(13/42)and 56.4％(22/39)respectively,x2=7.00,P=0.030].The initial programming time of MER-guided remote programming group was significantly shorter than that of the outpatient conventional programming group and remote conventional programming group[M(Q1,Q3):43.5(36.0,54.0)min,125.0(106.0,134.0)min and 124.0(104.5,150.0)min respectively,H=79.72,P＜0.001].The number of discomforts was significantly less than that of the outpatient conventional programming group and remote conventional programming group[M(Q1,Q3):1(0,1),3(3,3)and 3(3,3)respectively,H=86.17,P＜0.001].Conclusions Postoperative remote programming for PD patients can achieve therapeutic efficacy comparable to that of outpatient programming.The MER results can be used to guide the selection of programming contacts and improve the efficiency of remote programming with fewer adverse events,which is worthy of clinical promotion and application.
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