Objective: To evaluate clinical and neurophysiologic characteristics that may predict a positive clinical response to adaptive deep brain stimulation (aDBS) in patients previously stable on continuous (c)DBS.

Background: Alpha-beta responsive aDBS has been demonstrated to be safe and effective relative to stable cDBS. Widespread adoption of aDBS programming will require an improved framework for the selection of patients and optimal aDBS parameters.

Method: The ADAPT-PD Trial (NCT04547712) was an international pivotal trial with an open-label evaluation to cDBS of two aDBS modes (single threshold, ST-aDBS; dual threshold, DT-aDBS) in participants previously stable ON cDBS. We retrospectively assessed the relationship between baseline cDBS evaluation phase characteristics and clinical response to aDBS.

Results: Sixty participants (mean [SD] age 61.1 [8.15] years; 41 [68.3%] male) completed aDBS evaluation (43 both modes, 5 ST-aDBS only, 12 DT-aDBS only) and were included in the analysis. During the daytime, average stimulation amplitude was reduced with aDBS compared to cDBS (difference in daily mean amplitude ST-aDBS: -0.31±0.51mA, P<0.001, DT-aDBS -0.20±0.60mA, P=0.01). There was no association between change in daytime stimulation amplitude and change in “On” time without troublesome dyskinesia (“On” time) for either aDBS mode (ST-aDBS: r=0.08, P=0.63; DT-aDBS: r=-0.04, P=0.78). Average nighttime stimulation amplitude was also reduced during aDBS compared to cDBS (difference of mean amplitude ST-aDBS: -0.4±0.53mA, DT-aDBS: -0.43±0.61mA; both P<0.001). There was no association between change in nighttime stimulation amplitude and change in Parkinson’s Disease Sleep Scale (ST-aDBS: r=0.14, P=0.37; DT-aDBS: r=0.11, P=0.43). Participants who chose ST-aDBS at long-term follow up had a higher duty cycle (calculated during ST-aDBS Evaluation) compared to participants who did not (chose ST-aDBS: 0.43±0.20, did not choose ST-aDBS: 0.32±0.27, P=0.018).

Conclusion: aDBS increased “On” time despite utilizing a lower average stimulation current compared to cDBS therapy. Improvements in “On” time and sleep quality with aDBS did not correlate with average stimulation levels. ST-aDBS appears to be selected more frequently for long-term use when higher duty cycles are employed. Further real-world studies are necessary to establish optimal strategies for selecting the most effective aDBS parameters.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/exploring-clinical-and-neurophysiologic-predictors-of-adaptive-deep-brain-stimulation-response-in-parkinsons-disease/