Influence of Online Sessions via a Deep Brain Stimulation Device: Prospective, Single-Arm, Longitudinal, Nonrandomized Self-Controlled Cohort Study

Background: Deep brain stimulation (DBS) is widely performed in patients with advanced Parkinson disease (PD). Recent advances in technology have facilitated remote programming of DBS devices, reflecting an emerging trend in neuromodulation approaches, and offering a potential framework for patient-centered care. These online sessions for patients with PD who underwent de novo implantation of DBS devices have been reported to be safe and effective, similar to in-clinic sessions. Currently, evidence for patients with chronically implanted DBS devices remains limited. Objective: This study aimed to evaluate the safety, feasibility, and preliminary efficacy of online sessions for patients with PD who had chronically implanted DBS devices, and to determine whether this approach could reduce patient burden without compromising clinical management. Methods: A prospective, single-arm, longitudinal, nonrandomized, self-controlled cohort study was conducted at 2 centers in Japan. Eighteen patients with PD who had chronically implanted DBS devices were enrolled. Two in-clinic sessions were substituted with online sessions. The Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III scores were assessed at baseline, after in-clinic sessions, and online sessions. The Multidimensional Evaluation Scale for Patient Impression Change-Japanese version, Patient's Global Impression of Change, and Clinical Global Impression of Change were each administered after both in‑clinic and online sessions. The Telehealth Usability Questionnaire and the Online Usability Questionnaire for Programming were evaluated once after online sessions. Results: The Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III scores did not differ significantly across the 3 assessments. The Multidimensional Evaluation Scale for Patient Impression Change-Japanese version scores revealed that no items but item 3, "overall sleep," significantly worsened after online sessions. The Patient's Global Impression of Change and Clinical Global Impression of Change scores were comparable between in-clinic and online sessions. The Telehealth Usability Questionnaire scores indicated that online sessions were generally favorable, although the "Reliability" was rated comparatively lower. The mean total time and cost saved per visit were 280 minutes and 7974 yen (US $1≈155 JPY), respectively. One patient experienced a fall and lumbar compression fracture during the online visit period and dropped out of the study because of hospitalization. Conclusions: Online sessions may be a feasible option for a subset of patients with PD carrying chronically implanted DBS devices. Although online sessions cannot fully replace in-person assessments, they may serve as a practical alternative when adequate caregiver support, sufficient digital literacy, and a reliable connection are ensured. Clinicians should note that sleep-related symptoms may worsen in some patients. While time and cost savings are not direct indicators of care quality, these benefits still provide meaningful support for patients and caregivers. Overall, online sessions may complement routine follow-up in stable patients undergoing chronic DBS therapy.