Objectives Evidence suggests that non-conventional programming may improve deep brain stimulation (DBS) therapy for movement disorders. The primary objective was to assess feasibility of testing the tolerability of several non-conventional settings in Parkinson’s disease (PD) and essential tremor (ET) subjects in a single office visit. Secondary objectives were to explore for potential efficacy signals and to assess the energy demand on the implantable pulse-generators (IPG). Materials and Methods A custom firmware (FW) application was developed and acutely uploaded to the IPGs of 8 PD and 3 ET subjects, allowing delivery of several non-conventional DBS settings, including narrow pulse widths, square biphasic pulses and irregular pulse patterns. Standard clinical rating scales and several objective measures were used to compare motor outcomes with sham, clinically-optimal and non-conventional settings. Blinded and randomized testing was conducted in a traditional office setting. Results Overall, the non-conventional settings were well tolerated. Under these conditions it was also possible to detect clinically-relevant differences in DBS responses using clinical rating scales but not objective measures. Compared to the clinically-optimal settings, some non-conventional settings appeared to offer similar benefit (e.g. narrow pulse widths) and others lesser benefit. Moreover, the results suggest that square biphasic pulses may deliver greater benefit. No unexpected IPG efficiency disadvantages were associated with delivering non-conventional settings. Conclusions It is feasible to acutely screen non-conventional DBS settings using controlled study designs in traditional office settings. Simple IPG FW upgrades may provide more DBS programming options for optimizing therapy. Potential advantages of narrow and biphasic pulses deserve follow up.

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