Chronic Adaptive Deep Brain Stimulation in Parkinson s Disease: ADAPT-START Findings and Programming Principles

Deep brain stimulation (DBS) is an established treatment for advanced Parkinsons disease (PD), yet conventional DBS (cDBS) may provide suboptimal symptom control and can induce adverse effects, particularly on gait. Adaptive DBS (aDBS), which dynamically adjusts stimulation amplitude in response to subthalamic beta oscillatory activity, offers the potential for superior outcomes; however, its clinical benefits and programming strategies remain incompletely defined. Between January and April 2025, we consecutively offered the opportunity to test aDBS with the dual threshold algorithm to the first 20 PD patients with chronic cDBS and a Percept family neurostimulator who attended scheduled visits at our center. Nine were eligible and tested the aDBS mode. The primary reasons for exclusion or delayed programming were the presence of signal artifacts, absence of a distinct alpha-beta peak, and clinically optimized stimulation settings that were incompatible with aDBS. Of nine eligible patients, by July 2025, five entered chronic aDBS, one reverted to cDBS by preference, and three remained in the optimization phase. In the five patients on chronic aDBS, unblinded MDS-UPDRS III assessment showed an average 35% greater motor improvement compared with cDBS. Gait outcomes improved most consistently, with an average 40% reduction in Freezing of Gait Questionnaire scores. These preliminary findings suggest that the dual threshold aDBS mode with the Percept system may provide clinical advantages over cDBS and is preferred by most eligible patients, although technical challenges and programming demands currently limit broader clinical implementation.