Objective: This is a case report of two patients to using adaptive subthalamic nucleus deep brain stimulation (aDBS) for refractory dyskinesia

Background: Although continuous subthalamic nucleus deep brain stimulation (cDBS) is an established treatment for Parkinson’s disease (PD), its efficacy can be limited by a narrow therapeutic window, resulting in stimulation-induced dyskinesia. This report evaluates the motor outcomes, quality of life (QoL) and mood of two patients in Hong Kong whose mode of stimulation was switched from cDBS to aDBS for the management of refractory dyskinesia.

Method: Two women (Case 1: age 63, 11-year PD duration; Case 2: age 65, 14-year PD duration) underwent cDBS in 2022 and 2023 respectively, and were switched to aDBS in late 2025. Clinical assessment included Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS -UPDRS) Chinese traditional version Part II for activity of daily living (ADL), Part 3 for motor, Parkinson’s disease questionnaire-39 (PDQ-39) to assess quality of life and mobility, and Depression Anxiety Stress Scale (DASS) to evaluate psychological symptoms at baseline (cDBS) and 3-month post-aDBS.

Results: Both patients experienced a reduction in dyskinesia and improvement in various clinical measures:

Case 1: Awake dyskinesia time decreased significantly from 100% (moderate) to 15% (mild). PDQ-39 mobility improved (63% to 53% ; lower= better), and MDS-UPDRS Part II scores improved in both “off” (11 to 9) and “on” (7 to 5) conditions . MDS-UPDRS Part III remained unchanged. Mood remained stable.

Case 2: Awake dyskinesia time was reduced from 31% to 18%. PDQ- 39 mobility remained unchanged and ADL improved from 83% to 58%. MDS-UPDRS Part II showed no change in “off” condition, but improved from 15 to 13 in “on” condition. MDS-UPDRS Part III improved from 55 to 50. Anxiety improved from mild to normal.

Conclusion: This report suggests aDBS offers superior therapeutic window compared with cDBS, especially for refractory dyskinesia. aDBS may also enhance ADL, QoL and mood of PD patients experiencing stimulation-related motor complications

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MDS Abstracts - https://www.mdsabstracts.org/abstract/adaptive-subthalamic-nucleus-deep-brain-stimulation-adbs-for-refractory-dyskinesia-in-parkinsons-disease-a-case-report-of-two-patients/