Center for Neurological Restoration, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Cerebrovascular Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Neuromodulation. 2021 Feb;24(2):331-336. doi: 10.1111/ner.13307. Epub 2020 Nov 10.
Deep brain stimulation (DBS) is a well-established therapy for the management of patients with advanced Parkinson's disease and other movement disorders. Patients implanted with DBS require life-long management of the medical device as well as medications. Patients are often challenged to frequently visit the specialized DBS centers and such challenges are aggravated depending on geography, socioeconomic factors, and support systems. We discuss the need for digital health solutions to overcome these barriers to better and safely take care of patients, especially in the current COVID-19 pandemic.
A review of the literature was conducted for technology and logistics necessary in forming a digital health program.
Digital health encounters can take place in both a synchronous and asynchronous manner. Factors involving patients include cognitive capacity, physical safety, physical capacity, connectivity, and technological security. Physician factors include examining the patient, system diagnostics, and adjusting stimulation or medications. Technology is focused on bridging the gap between patient and physician through integrating the DBS lead, implantable pulse generator (IPG), programmer, novel devices/applications to grade motor function, and teleconference modalities.
For patients with Parkinson's disease, digital health has the potential to drastically change the landscape after DBS surgery. Furthermore, technology is fundamental in connectivity, diagnostic evaluation, and security in order to create stable and useful patient-focused care.
深部脑刺激（DBS）是治疗晚期帕金森病和其他运动障碍患者的成熟疗法。植入 DBS 的患者需要对医疗设备以及药物进行终身管理。患者经常面临频繁前往专门的 DBS 中心就诊的挑战，而这种挑战会因地理位置、社会经济因素和支持系统而加剧。我们讨论了需要数字健康解决方案来克服这些障碍，以更好地安全照顾患者，尤其是在当前 COVID-19 大流行期间。
对形成数字健康计划所需的技术和物流进行了文献回顾。
数字健康可以以同步和异步的方式进行。涉及患者的因素包括认知能力、身体安全、身体能力、连接性和技术安全性。医生的因素包括检查患者、系统诊断和调整刺激或药物。技术专注于通过整合 DBS 导联、可植入脉冲发生器（IPG）、编程器、新型设备/应用程序来分级运动功能以及远程会议模式，在患者和医生之间架起桥梁。
对于帕金森病患者，数字健康有可能在 DBS 手术后彻底改变现状。此外，技术是连接、诊断评估和安全性的基础，以创建稳定且有用的以患者为中心的护理。
