Management of Parkinson's disease patients after DBS by remote programming: preliminary application of single center during quarantine of 2019-nCoV

Abstract

Introduction Deep brain stimulation (DBS) is an effective treatment for patients with Parkinson’s disease (PD). On time follow-up and timely programing of symptoms are important measures to maintain the effectiveness of DBS. Due to the highly contagious nature of 2019-nCoV, patients were quarantined. With the help of Internet technologies, we continued to provide motor and non-motor symptom assessment and remote programming services for postsurgical PD-DBS patients during this extraordinary period. Methods A retrospective analysis was performed on postsurgical PD-DBS patients who could not come to our hospital for programming due to the impact of the 2019-nCoV. The differences between the pre- and post-programming groups were analyzed. We designed a 5-level Likert rating scale to evaluate the effects and convenience of the remote programming and Internet self-evaluation procedures. Results Of the 36 patients engaged in the remote programming, 32 patients met the inclusion criteria. Four of the 32 patients set initiated stimulation parameters, and the other 28 patients had significant improvement in UPDRS-III. Nearly all the 28 patients were satisfied with the effect of the remote programming. Most of the patients were willing to use remote programming again. Conclusion Remote programming based on the online evaluation of patient’s symptoms can help improve motor symptoms of postsurgical DBS patients with PD during the quarantine period caused by 2019-nCoV. Electronic supplementary material The online version of this article (10.1007/s00415-020-10273-z) contains supplementary material, which is available to authorized users.

The Use of Remote Programming for Spinal Cord Stimulation for Patients With Chronic Pain During the COVID-19 Outbreak in China

“…There have been reports of remote programming of DBS for neurological disorder including Parkinson's disease (28)(29)(30)(31), dystonia (32), and obsessive-compulsive disorder (OCD) (33). They confirmed that a remote system is in high demand due to the huge burden of DBS postoperative care (34), and that remote programming is able to effectively maintain the effectiveness of DBS treatment (28,30,32,33). Similar to DBS, in patients who just underwent SCS implantation, regular followups were also affected by COVID-19 epidemic.…”

“…However, rigidity, which is one of its major symptoms, is hard to evaluate during video-based remote programming. The other symptoms such as dyskinesia and tremor, although can be followed through video, may respond to DBS parameter changes slowly (30). In contrast, for SCS remote programming for pain management, patients note real-time changes of their pain in response to the stimulation and easily convey the information to physicians.…”

“…Remote consultation was applied in multiple countries (24–26), including China (27). There have been reports of remote programming of DBS for neurological disorder including Parkinson's disease (28–31), dystonia (32), and obsessive–compulsive disorder (OCD) (33). They confirmed that a remote system is in high demand due to the huge burden of DBS postoperative care (34), and that remote programming is able to effectively maintain the effectiveness of DBS treatment (28,30,32,33).…”

Parkinson’s Disease and the COVID-19 Pandemic

“…Other adaptive strategies such as remote DBS programming based on the online evaluation of patient’s symptoms have been shown to help improve motor symptoms of postsurgical DBS patients with PD during quarantine [ 68 ]. Other decision algorithms for patients with advanced therapies have been published in order to help with rapid dissemination of management strategies during the peak of the pandemic crisis [ 59, 69 ].…”

Neuromodulation Approaches in Parkinson’s Disease Using Deep Brain Stimulation and Transcranial Magnetic Stimulation

“…Two preliminary studies out of China investigated the use of remote programming with promising results. 58,59 If implemented, remote programming could save patients considerable time and money. Programming is often a trial-and-error process, and although there are general guidelines, validated evidence-based programming protocols do not exist.…”