Objective: To identify patient characteristics predicting adaptive deep brain stimulation (aDBS) superiority over conventional DBS (cDBS) in Parkinson’s disease (PD).

Background: Adaptive DBS, modulated in real-time by beta-band activity from subthalamic nucleus local field potentials, may enhance symptom management in PD. However, clinical outcomes vary, necessitating characterization of patients most likely to benefit.

Method: Nine patients received bilateral STN-DBS with Percept PC. Adaptive Impact (AI) was defined as the difference in improvement rates (aDBS minus cDBS), where positive values indicate aDBS superiority. Beta-band sensitivity was defined as the proportion of OFF states captured by elevated beta power, and specificity as the proportion of ON states identified by reduced power, based on 1–2-day patient-reported diaries. Spearman correlations assessed associations between AI and baseline factors as well as the sensitivity/specificity metrics. Multiple linear regressions (adjusting for Age, Disease duration) examined key predictors of OFF-time and dyskinesia-time AI.

Results: aDBS was less effective than cDBS in reducing OFF-time (median AI: –11.36% [IQR: –17.53 to –6.87%], p<0.01) and increasing ON-time (–7.36% [–30.19 to –5.81%], p<0.01). Lower baseline UPDRS part 4 correlated negatively with OFF-time AI (rho=–0.57, p<0.05). Beta-band sensitivity showed a non-significant moderate positive correlation with OFF-time AI (rho=0.44, p=0.27), whereas specificity had minimal and non-significant correlation with dyskinesia (rho=–0.02, p=0.97). A multiple linear regression including beta-band sensitivity (p=0.017), Age, and Disease duration explained OFF-time AI (R²=0.90, p=0.019). In contrast, models involving UPDRS part 4 for OFF-time or beta-band specificity for dyskinesia-time were non-significant.

Conclusion: aDBS may particularly benefit patients with milder motor complications and those with higher beta-band sensitivity for detecting OFF states, while beta-band specificity provided limited predictive value for dyskinesia reduction. These findings support tailoring aDBS indication based on individual patient characteristics.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/predictors-of-clinical-benefit-from-adaptive-dbs-compared-to-conventional-dbs-in-parkinsons-disease/