Local field potential biomarkers for adaptive deep brain stimulation in Parkinson's disease: A scoping review

Parkinson's disease (PD) is the second most common neurodegenerative disorder in the elderly. Conventionally, to combat the symptoms, drugs such as Levodopa and conventional deep brain stimulation (DBS) are routinely used. However, with time, the efficiency of both treatment modalities wears off and accompany side effects. Advocating for the need to explore subsequent management options such as adaptive DBS (aDBS) - a tailor-made DBS promising more personalized and favorable outcomes. The main objective of this review was to explore local field potentials (LFPs) as biomarkers for aDBS in PD. In addition, to investigate any correlations between the LFPs biomarkers, their physiology, and how they affect the quality of aDBS.

A literature search was conducted using two primary electronic databases, PubMed and Scopus, which were examined from 2005 to April 2026. The inclusion criteria were set as LFPs within the DBS framework, focusing on biomarkers such as beta, gamma, phase-amplitude coupling (PAC), or oscillatory activity in PD. A narrative data synthesis was conducted to chart and summarize the main findings from the included studies.

A total of 73 articles were included in this review. Suppression of exaggerated beta-band oscillations (13- 35 Hz) consistently correlated with improved motor performance and emerged as the most validated feedback signal for adaptive stimulation. Gamma oscillations demonstrated an emerging role in differentiating motor states, while PAC and other low-frequency oscillations remain exploratory, showing promise for integration with multimodal systems. Based on accumulated evidence, biomarkers were categorized into three tiers: Established (beta-band activity), emerging (gamma oscillations), and exploratory (PAC and others).

Although DBS has shown marked improvement in symptoms, LFP-based aDBS represents a future toward personalized, precise, and adaptive treatment for PD; clinical usage of aDBS requires standardization and broader validation.