Objective: To describe the treatment process and outcomes of the first patients with Parkinson’s disease (PD) treated with adaptive DBS (aDBS) within routine clinical care in the Amsterdam UMC.

Background: In PD, the local field potential (LFP) spectral power of beta oscillations (13-30 Hz) within the subthalamic nucleus (STN) is linked to contralateral motor symptom severity. Beta power typically decreases after levodopa intake or deep brain stimulation (DBS) and can guide aDBS, which adjusts stimulation in real-time using closed-loop control. aDBS may alleviate stimulation-induced adverse effects of continuous DBS (cDBS) or levodopa-related adverse effects and it may address insufficient efficacy during OFF levodopa states. In January 2025, the first aDBS system became commercially available outside Japan.

Method: Patients were eligible for aDBS treatment if they experienced daily OFF periods, ON-related adverse effects and/or stimulation-induced adverse effects despite optimal titration of cDBS parameters. Electrode positioning was confirmed using 7T MRI connectivity analysis. Patients were initially treated using a dual-threshold algorithm. The beta frequency band of interest was identified using LFP spectral densities obtained in OFF and ON levodopa states. LFP thresholds were determined using 1-2 weeks of at-home recordings and in-clinic recordings. Stimulation limits were determined based on medical history and in-clinic testing. The programming settings were optimized until the desired clinical effect was reached or no more improvement was expected.

Results: As of March 2025, six patients received aDBS treatment for residual dyskinesias (N=2), insufficient efficacy (n=4) and/or stimulation-induced adverse effects (N=4). For one patient, the treatment was discontinued as no satisfactory clinical outcome could be reached because the stimulation montage on the adapting lead was sensing-incompatible and the contralateral beta power did not sufficiently reflect his symptoms. Two patients were considered minimally or much improved based on the Clinical Global Impression – Improvement scale (scores 3 and 2, respectively). The settings were still being optimized for the remaining patients.

Conclusion: aDBS is a feasible and promising treatment for PD patients with residual motor fluctuations or stimulation-induced adverse effects despite optimal cDBS treatment.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/adaptive-deep-brain-stimulation-for-parkinsons-disease-in-routine-clinical-care-first-experiences/