Use of telemedicine in managing deep brain stimulation for movement disorders

Abstract

© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION During the global COVID19 pandemic, there has been a move towards ‘remote’ healthcare and minimising nonessential traffic through primary and secondary care to minimise the spread of the virus. Studies have shown that patients with deep brain stimulators (DBSs) have a high requirement for input regarding programming and maintenance of their systems. 2 Patients with neuromodulators for movement disorders are usually seen by specialist nurses for followup. One component of assessment is checking the implantable pulse generators (IPGs) which are the batteries for the stimulation, and planning surgery for replacement in a timely manner. If this is not done, it can lead to clinical crises for the patient, emergency admission and longer stays in hospital while they wait for emergency surgery and recover from the episode leading to significant mental and physical impact. Monitoring of recharging patterns, where the IPG is rechargeable, is valuable in highlighting any problems. To maintain clinical care during the pandemic, there was a move towards video and audio conferencing of outpatient appointments for new and followup patients within neurosurgery. 4 Studies suggest that this method of clinical followup is acceptable to patients with DBS. 5 Other options for telemedicine are secure interactive software for communication with the patient via their own devices such as laptop, tablets and mobile telephones. Reminders and notifications can be sent securely via this medium between clinicians and patients. Such telemedicine allows management of IPGs to be done remotely. Use of telemedicine can be technically and logistically challenging due to cost and hardware required, so it is important to understand its utility, as well as patient experience, tolerability and impact on clinical resources. Studies during COVID19 suggest its use in managing DBS for Parkinson’s disease (PD) was effective. If valuable then its use may be continued beyond the COVID19 pandemic to reduce the workload on clinical staff and enable contemporaneous monitoring of patients. We reviewed our experience with telemedicine in managing our cohort of patients with DBS for movement disorder.