Chronic adaptive deep brain stimulation for Parkinson's disease: clinical outcomes and programming strategies

Adaptive deep brain stimulation (DBS) dynamically adjusts stimulation amplitude based on neurophysiological feedback and may alleviate residual motor fluctuations in patients with Parkinson's disease. However, potential clinical benefits and programming strategies remain poorly understood. We programmed eight patients with Parkinson's disease on commercially available Dual Threshold adaptive DBS based on subthalamic beta power. Symptom severity was evaluated at home using ecological momentary assessments during two weeks of both continuous and adaptive DBS. Patients were not blinded to the stimulation mode. On the group level, overall well-being significantly improved with adaptive DBS (p = 0.007), and there was a non-significant trend toward enhanced general movement (p = 0.058). Within-subject analysis showed a significant improvement in overall well-being and general movement in three of eight patients. Six of eight patients chose to remain on adaptive DBS. Programming challenges included biomarker selection, threshold definition, and artifact-related maladaptation, for which targeted strategies are reported. Our findings support adaptive DBS as a potential option for selected Parkinson's disease patients with persistent motor symptoms on continuous DBS. We propose a three-step programming approach to guide clinical implementation of adaptive DBS.