Remote Versus In-Person Follow-up Programming After Subthalamic Deep Brain Stimulation for Parkinson's Disease: A Multicenter Randomized Noninferiority Trial.

BACKGROUND

Remote programming of deep brain stimulation may improve access to specialized postoperative care for people with Parkinson's disease, but prospective randomized evidence remains limited.

OBJECTIVE

We aimed to determine whether remote follow-up programming after standardized inpatient initiation is noninferior to conventional in-person follow-up programming for motor outcomes during the early postoperative period.

METHODS

In this prospective, randomized, open-label, multicenter noninferiority trial, adults with idiopathic Parkinson's disease who recently underwent bilateral subthalamic nucleus deep brain stimulation implantation at six German centers were randomly assigned 1:1 to conventional in-person follow-up programming or remote follow-up programming through a secure telemedicine platform during the first 90 days after surgery. All participants underwent initial in-person postoperative programming before randomization. The primary outcome was the Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part III score at 90 days in the medication on and stimulation ON state. The prespecified noninferiority margin was 5 points.

RESULTS

Fifty-two participants were randomly assigned. The per-protocol population included 26 participants in the conventional care group and 22 in the remote programming group. The between-group median difference of the primary endpoint was -2.5 points (95% confidence interval, -9.0 to 2.0), meeting the prespecified noninferiority criterion. Secondary clinical outcomes and patient-reported outcomes were broadly comparable between groups. Serious adverse events occurred at similar frequencies in both groups, and no deaths occurred.

CONCLUSIONS

Remote follow-up programming after standardized inpatient initiation achieved motor outcomes noninferior to conventional in-person follow-up during the first 3 months, with no clear short-term safety signal. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.