ABSTRACT
Objective: To assess the utility of the recently FDA approved Virtual Clinic platform that enables clinicians to remotely make programming changes in DBS patients. Background: DBS in Parkinson's disease and Essential tremor requires multiple in-person programming sessions for therapy optimization and management. Until recently, this was only possible through inperson clinic sessions which place time, travel and fiscal burdens on patients and caregivers limiting their access to care. This has an even greater bearing on patients that are dependent on caregivers, need to take time off from work or are concerned about exposure during COVID-19. The recent FDA approved NeuroSphere™ Virtual Clinic enables clinicians for the first time to remotely make programming changes over the internet to help DBS patients. Methods: 34 patients provided signed written consent to Abbott or verbal consent to the Clinician to be enrolled. The enrolled Abbott Infinity™ IPGs were securely mapped to authorized Clinicians. Software on programming devices was upgraded without requiring any hardware or firmware changes. Patients initiated remote sessions and Clinicians securely connected to the IPGs using unique logins and multi-factor authentication. Stimulation changes were synchronized with integrated video and a failsafe mechanism ensured continuity of therapy in case of network failure. Results: Of the 34 patients programmed remotely, 74% benefited from stimulation changes, 26% from side effects resolution, 9% from battery status check, 6% were out of the country when they needed intervention, 29% completed routine follow-up. The use of this platform has allowed seamless virtual patient visits reducing the patient burdens related to access to care as well as increasing throughput in our clinic. We have also billed for these sessions for reimbursement in the US using the Telemedicine modifier code (95). The average time to establish a session has been less than 1 minute with no perceptible difference in system checks and stimulation changes. Remote programming is both clinically viable and valuable to patients, caregivers and clinicians. Conclusion: Remote programming is both clinically viable and valuable to patients, caregivers and clinicians.