Chronic adaptive deep brain stimulation in Parkinson's disease: ADAPT-START findings and programming principles

Area of Science:

• Neurology
• Neurosurgery
• Biomedical Engineering

Background:

• Conventional deep brain stimulation (cDBS) is a standard Parkinson's disease (PD) treatment.
• cDBS can result in suboptimal symptom management and side effects, particularly impacting gait.
• Adaptive deep brain stimulation (aDBS) offers potential for improved outcomes by adjusting stimulation based on brain activity.

Purpose of the Study:

• To outline programming principles for dual-threshold aDBS in PD patients.
• To evaluate the preliminary clinical efficacy of aDBS compared to cDBS.
• To identify technical and programming constraints affecting aDBS adoption.

Main Methods:

• Prospective study offering dual-threshold aDBS to 20 PD patients with existing cDBS.
• Nine patients were eligible for aDBS based on signal quality, beta peak presence, and compatible settings.
• Clinical efficacy assessed using unblinded MDS-UPDRS III scores.

Main Results:

• Five patients continued chronic aDBS, one preferred cDBS, and three were undergoing optimization.
• aDBS demonstrated approximately 35% greater motor improvement compared to cDBS on MDS-UPDRS III.
• Gait symptoms showed the most consistent benefits with aDBS.

Conclusions:

• Dual-threshold aDBS appears clinically advantageous for Parkinson's disease management.
• Significant improvements in motor function and gait were observed.
• Current technical and programming limitations may hinder widespread aDBS implementation.