Fixing a Shaky Video to Remotely Program Deep Brain Stimulation

Deep brain stimulation (DBS) is an increasingly utilized therapy for treating refractory tremor in Parkinson's disease (PD). Remote care can improve patient access to specialized DBS clinics. Here, we present a novel strategy to assess tremor remotely during DBS programming. We report the case of a 65-year-old female diagnosed with PD who showed only partial responsiveness to levodopa. She underwent bilateral subthalamic nucleus DBS surgery and was implanted with an Infinity™ implantable pulse generator with directional leads (Abbott, Chicago, IL, USA). Given that she resided 1,500 km from our center, device programming was performed remotely using the Neurosphere™ Virtual Clinic platform. The patient was instructed to hold her controller in a fixed position until her resting tremor re-emerged, which was visibly evident through a shaking video frame. Stimulation parameters were then optimized until the video frame became still. She reported sustained benefit during follow-up. We propose that this alternative method for remotely assessing upper limb tremor may offer advantages for healthcare providers, allowing them to base stimulation adjustments on visually observable tremor severity.