Objective: To clarify practical factors for optimizing adaptive deep brain stimulation (aDBS) to achieve better clinical outcomes in Parkinson’s disease (PD).

Background: aDBS is a closed-loop DBS strategy expected to improve control of motor complications compared with conventional DBS (cDBS). We hypothesized that patients with stronger beta-motor state correspondence would derive greater benefit from aDBS relative to cDBS.

Method: We conducted a double-blind, randomized, crossover trial in 9 PD patients with bilateral subthalamic nucleus DBS (Mov Disord 2025;40:S1052). After a four-month postoperative stabilization period, patients underwent consecutive one-month periods of cDBS and aDBS. The aDBS system used a dual-threshold algorithm.

Primary outcomes—daily ON/OFF durations and dyskinesia duration did not show superiority of aDBS over cDBS. The duration of troublesome dyskinesia showed minimal change in favor of aDBS. In a post-hoc analysis, we examined the relationship between beta power and motor states in six patients. The ON state was defined as the best 30% of akinetic performance assessed by a physician, while the OFF state was defined as the worst 30%. Assessments were performed blind to beta power. Correspondence ratios between the OFF state and beta power above the upper threshold, and between the ON state and beta power below the lower threshold, were calculated; the correlation between these ratios and the primary outcomes was examined.

Results: The overall OFF-beta correspondence ratio (43%) was lower than the overall ON-beta correspondence ratio (65%). OFF-beta correspondence showed a moderate positive association with ON duration increase (Pearson r = 0.47; Spearman ρ = 0.49), suggesting that patients with stronger OFF-beta correspondence tended to have longer ON duration. OFF-beta correspondence was also negatively associated with OFF duration (r = −0.47; ρ = −0.49). Although statistical significance was not reached because of the small sample size, both Pearson and Spearman analyses showed consistent slope directions, suggesting a systematic relationship.

Conclusion: Strong OFF-beta correspondence appears important for improving wearing-off with aDBS, while strong ON-beta correspondence may help reduce dyskinesia duration. Careful titration of stimulation parameters and beta thresholds may be essential to achieve greater benefit with aDBS than with cDBS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/beta-motor-state-correspondence-as-a-predictor-of-adaptive-deep-brain-stimulation-benefit-in-parkinsons-disease/