Objective: To describe initial outcomes of alpha-beta (8-30Hz)-guided subthalamic nucleus (STN) adaptive deep brain stimulation (aDBS) in Parkinson disease (PD) in a single-center cohort.

Background: Continuous DBS (cDBS) is an established therapy for PD with motor fluctuations, but it can cause fluctuations and side-effects. aDBS adjusts amplitude in real time based on neurophysiological signals, such as local field potential (LFP) activity. Real-world data on aDBS are still scarce.

Method: A consecutive PD STN-DBS cohort was recruited after surgery and underwent conventional programming up to 3 months post-op. At 3 and 6 months post-op, LFP-based settings (LFP-cDBS) were implemented. aDBS was started 7 months post-op and reviewed in the short (8-9 months post-op) and medium term (10-13 months post-op). Demographics, levodopa-equivalent daily dose (LEDD), clinical scales (Movement Disorders Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) part IV, 39-item Parkinson’s Disease Questionnaire (PDQ-39)), neurophysiological data (tracked LFP bands), and patient feedback were collected. Statistics are medians (interquartile ranges), counts, percentages, and comparisons via Wilcoxon signed-rank tests.

Results: Eighteen patients (34 hemispheres; age: 58.5 (55.6-66.6) years, 7 (38.9%) females, PD duration: 10 (9-11) years) were switched to aDBS. Of those, 17 and 15 remained on aDBS at the short-term and medium-term timepoints respectively. Reasons for discontinuation were dyskinesias (1), headache/falls (1), and irritability (1). LEDD was comparable between LFP-cDBS and aDBS. Regarding motor fluctuations (Part IV), aDBS (5 (2-8)) was superior to LFP-cDBS (6.5 (5-9))(p = 0.021) in the short term and in terms of quality of life (QoL), aDBS was superior to LFP-cDBS in the medium term (PDQ-39 Summary Index score: LFP-cDBS: 10.3 (4.6-18.1), aDBS: 8.9 (4.3-12.1); p =0.003). Fifteen patients (83%) preferred aDBS. The optimal sensing frequency band stayed constant during the study.

Conclusion: aDBS is a feasible alternative to cDBS. In this cohort, it was safe, preferred by patients, comparable to cDBS and superior for fluctuations and QoL. Further work is needed on its longer-term value and potential predictors of efficacy. As it requires a significant time investment, aDBS may be best prioritised for patient subgroups with suboptimal symptom control on cDBS (fluctuations, side-effects).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/adaptive-deep-brain-stimulation-in-parkinson-disease-preliminary-single-center-results/