Encouraging results for adaptive DBS for Parkinson’s disease

Adaptive deep brain stimulation (DBS) in Parkinson’s disease is feasible, safe, and intuitively interacts with its pathophysiology, and is potentially effective. It is also challenging, requiring significant effort per patient. These were the main conclusions drawn from early experiences with adaptive DBS at a specialised Dutch centre.

 

Dr Martijn Beudel (Amsterdam University Medical Center, The Netherlands) said, “DBS of the subthalamic nucleus (STN) is the gold standard for advanced Parkinson’s disease, but efficacy and safety may be suboptimal” [1]. Dr Beudel said DBS of the STN is a double-edged sword. During the on-phase, DBS may reduce movement velocity, while in the off-phase, it enhances it. However, conventional stimulation is delivered continuously (24/7) and does not adjust to daily fluctuations, such as on/off fluctuations, fatigue, the stun-effect, or changes in disease progression. Dr Beudel: “The question is whether stimulation can be applied more intelligently, adjusting to the patients’ real-time needs.”

This is exactly what new adaptive DBS technology is designed to do, providing dynamic symptom-related stimulation by sensing neuronal activity. A recent trial led to its approval for adaptive DBS for Parkinson’s disease [2]. Dr Beudel's group has since started to apply adaptive DBS in 12 patients who experienced a lack of efficacy or excessive side effects from conventional DBS [1]. The goal is to better define which patients are more suitable for adaptive DBS, how it should be implemented, and which symptoms are most likely to benefit.

There is a wide range of indications, including persistent dyskinesia, gait disturbances, dysarthria, motor fluctuations, and apathy, with some patients presenting multiple symptoms. Outcome measures are still limited, according to Dr Beudel, and are based on the Global Clinical Impression of Improvements (GCI-I). Using this scale, 60% of patients showed improvements, 20% did not, and 20% are still pending. “To proceed, we need more robust outcome reporting, ideally fast outcome reporting with low biases and clear relevance to the quality-of-life of patients,” concluded Dr Beudel. “We also need to know how to titrate these adaptive algorithms for integration into clinical practice.”

1. Beudel M, et al. Adaptive deep brain stimulation for Parkinson’s disease in routine clinical care: First experiences. LBN_04, EAN Congress 2025, 21-24 June 2025, Helsinki, Finland.
2. Stanslaski S, et al. NPJ Parkinsons Dis. 2024;10(1):174.

 

Medical writing support was provided by Michiel Tent.

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Posted on 26 June 202526 June 2025