{"doi":"10.1002/mdc3.14181","title":"Automated Motion Sensor‐Based Functional Mapping Improves Deep Brain Stimulation Programming Efficiency","abstract":"Deep brain stimulation (DBS) is an established therapy for Parkinson's disease (PD).1, 2 Although highly effective in reducing motor fluctuations, the success of DBS depends on identifying patient-specific stimulation parameters. Clinicians systematically test a plethora of stimulation parameters, a process known as monopolar review, to define stimulation thresholds associated with clinical benefits and side effects.3 These thresholds can be used to define a therapeutic window (threshold for side effect minus threshold for clinical benefit) and identify stimulation parameters that are most likely to reduce patient symptoms without causing side effects. On average, monopolar review requires 60 to 90 minutes to test various settings and depends on patient participation and clinician experience to achieve optimal outcomes.4 To assist with this task, automated approaches based on physiology or imaging have been tested.5, 6 Motion-sensor-based functional mapping (SBFM) is another promising approach to efficiently navigate the complexity of DBS programming. Previous pilot studies showed the feasibility and preliminary efficacy of SBFM.7-10 Here, we sought to compare the outcomes of a fully integrated SBFM system for automated programming versus standard-of-care (SoC) programming with experienced clinicians in a blinded, multicenter, crossover randomized trial. We hypothesized that SBFM would determine the optimal stimulation settings with fewer iterations, shorter programming time, and similar clinical outcomes compared to clinician-based programming. Eight patients with PD (6 males, 2 females; age 53–69 years) who had received a subthalamic nucleus-DBS or globus pallidus internus-DBS implant using the multiple independent current control Vercise DBS systems within 3 weeks before enrollment were recruited in this study. The implanted leads were either eight-ring contact linear leads or eight-contact direction leads used in linear mode, equivalent to a four-ring contact lead. Six patients had bilateral and two unilateral implants, resulting in a total of 14 DBS leads requiring programming. The study consisted of a randomized, crossover, controlled trial of SBFM versus SoC programming (see Data S1). Each participant completed two DBS programming sessions in random order within a 3-week window: one using SoC programming and the other using the SBFM system (Kinesia, StimPoint, Great Lakes NeuroTechnologies, Cleveland, OH), which consists of a software application that runs on an Android tablet, a finger-worn kinesia motion sensor unit, and a wireless charge-pad. Details of the SBFM programming are described in Data S1. Participants withheld PD medication for 10 to 12 hours before each programming session. A blinded rater performed Unified Parkinson's Disease Rating Scale part III (UPDRS-III) assessments before and after each programming session. The stimulation location, time required to program the DBS system, number of settings tested, and stimulation amplitude were measured. Outcomes were compared between SoC and SBFM groups. Concordance between the two groups was calculated by comparing the stimulation location. The time required for programming, number of settings, and stimulation amplitude were compared between groups using a Wilcoxon signed-rank test. All P-values reported are two-tailed and a P < 0.05 was considered statistically significant. The stimulation levels were concordant in 10 DBS leads and discordant in four. Among the discordant settings, in two leads, the stimulation levels were localized within one level between the two treatment groups. The SBFM system significantly reduced the number of settings tested (median 9 vs. 31, P = 0.047). There was a trend toward lower programming time and final current amplitude in the SBFM group (median time: 22 vs. 39 minute; median amplitude: 2.0 vs. 2.5 mA). Study results for all participants are shown in Table 1. Total UPDRS-III scores improved significantly for both groups (senso","journal":"Movement Disorders Clinical Practice","year":2024,"id":502049,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9553,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":373826,"name":"Aaron J. Hadley","orcid":"0000-0003-4439-8199","position":1,"is_corresponding":false},{"id":1351825,"name":"Danielle Englert","orcid":null,"position":2,"is_corresponding":false},{"id":1351564,"name":"Nicholas I. Fleming","orcid":"0000-0002-5877-3052","position":3,"is_corresponding":false},{"id":487887,"name":"Benjamin L. Walter","orcid":"0000-0002-8323-6873","position":4,"is_corresponding":false},{"id":1351826,"name":"Erica Hennigs","orcid":null,"position":5,"is_corresponding":false},{"id":373831,"name":"Aristide Merola","orcid":"0000-0002-5587-726X","position":6,"is_corresponding":false},{"id":373827,"name":"Dustin A. Heldman","orcid":"0000-0002-1245-0557","position":7,"is_corresponding":false},{"id":1205731,"name":"Vibhor Krishna","orcid":"0000-0002-4141-4192","position":0,"is_corresponding":true}],"reference_count":10,"raw_metadata":null,"created_at":"2026-07-19T02:10:19.647285Z","pmid":"39136384","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}