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Updated: Apr 17, 2026

Controlling Parkinson's Disease With Adaptive Deep Brain Stimulation
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Automating Subthalamic Deep Brain Stimulation Programming with Evoked Resonant Neural Activity in Parkinson's

Kanae J Nagao1,2,3, Thushara Perera1,4, Matthew Petoe1,4,5

  • 1Medical Bionics Department, The University of Melbourne, Melbourne, Victoria, Australia.

Movement Disorders : Official Journal of the Movement Disorder Society
|April 15, 2026
PubMed
Summary

Evoked resonant neural activity (ERNA) programming offers an objective method for subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD). This approach provides acute motor benefits comparable to traditional methods, establishing a practical starting point for STN-DBS.

Keywords:
Parkinson's diseaseSTN‐DBSdeep brain stimulationevoked resonant neural activityneural biomarkersneurophysiologysubthalamic nucleus

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Area of Science:

  • Neurosurgery
  • Neurology
  • Biomedical Engineering

Background:

  • Subthalamic nucleus deep brain stimulation (STN-DBS) is crucial for Parkinson's disease (PD) management.
  • Optimal STN-DBS outcomes rely on precise stimulation of the dorsolateral STN.
  • Current clinical programming methods are heuristic, necessitating objective approaches for improved efficiency and consistency.

Purpose of the Study:

  • To evaluate the feasibility of STN-DBS programming guided by intraoperative evoked resonant neural activity (ERNA).
  • To assess the acute motor benefits of ERNA-guided STN-DBS programming in PD patients.
  • To compare ERNA-guided programming with conventional clinician and imaging-based methods.

Main Methods:

  • Twelve PD patients with well-positioned STN-DBS leads were assessed off-medication.
  • Acute motor benefit was evaluated double-blindly across three programming configurations: chronic clinician settings, imaging-guided, and an ERNA automated algorithm.
  • Therapeutic and side effect thresholds, along with fractionated current distribution, were compared.

Main Results:

  • ERNA programming yielded a 75.7% median improvement in Movement Disorder Society-Unified Parkinson's Disease Rating Scale-Part III scores.
  • ERNA programming efficacy was comparable to imaging (81.6%) and clinician programming (68.8%).
  • No significant differences were observed in therapeutic or side effect thresholds across programming methods.

Conclusions:

  • An ERNA-based algorithm achieved acute motor efficacy and tolerability equivalent to expert clinical and imaging-based STN-DBS programming.
  • ERNA recordings were rapid (<1 minute) and feasible under both awake and general anesthetic conditions.
  • Intraoperative ERNA offers a rapid, objective, and practical foundation for STN-DBS programming in Parkinson's disease.