Busch Johannes L, Kaplan Jonathan, Behnke Jennifer K, Witzig Victoria S, Drescher Luisa, Habets Jeroen G V, Kühn Andrea A
Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Berlin, Germany.
BIH Charité Junior Clinician Scientist Program, BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
NPJ Parkinsons Dis. 2025 Aug 29;11(1):264. doi: 10.1038/s41531-025-01124-7.
Adaptive deep brain stimulation (DBS) dynamically adjusts stimulation amplitude based on neurophysiological feedback and may alleviate residual motor fluctuations in patients with Parkinson's disease. However, potential clinical benefits and programming strategies remain poorly understood. We programmed eight patients with Parkinson's disease on commercially available Dual Threshold adaptive DBS based on subthalamic beta power. Symptom severity was evaluated at home using ecological momentary assessments during two weeks of both continuous and adaptive DBS. Patients were not blinded to the stimulation mode. On the group level, overall well-being significantly improved with adaptive DBS (p = 0.007), and there was a non-significant trend toward enhanced general movement (p = 0.058). Within-subject analysis showed a significant improvement in overall well-being and general movement in three of eight patients. Six of eight patients chose to remain on adaptive DBS. Programming challenges included biomarker selection, threshold definition, and artifact-related maladaptation, for which targeted strategies are reported. Our findings support adaptive DBS as a potential option for selected Parkinson's disease patients with persistent motor symptoms on continuous DBS. We propose a three-step programming approach to guide clinical implementation of adaptive DBS.
适应性深部脑刺激（DBS）基于神经生理反馈动态调整刺激幅度，可能减轻帕金森病患者的残余运动波动。然而，其潜在的临床益处和编程策略仍知之甚少。我们根据丘脑底核β功率，为8例帕金森病患者进行了市售双阈值适应性DBS编程。在连续DBS和适应性DBS的两周内，使用生态瞬时评估在家中评估症状严重程度。患者未对刺激模式设盲。在组水平上，适应性DBS使总体幸福感显著改善（p = 0.007），并且在一般运动增强方面有不显著的趋势（p = 0.058）。个体内分析显示，8例患者中有3例的总体幸福感和一般运动有显著改善。8例患者中有6例选择继续使用适应性DBS。编程挑战包括生物标志物选择、阈值定义和与伪迹相关的适应不良，本文报告了针对这些问题的策略。我们的研究结果支持适应性DBS作为在连续DBS治疗下仍有持续运动症状的部分帕金森病患者的一种潜在选择。我们提出一种三步编程方法来指导适应性DBS的临床应用。
