Adaptive Deep Brain Stimulation Benefits: Younger Patients with Persistent Wearing-off Symptoms.

Background: Parkinson's disease (PD) often involves motor fluctuations and dyskinesia, which are difficult to manage with medication alone. Conventional deep brain stimulation (cDBS) effectively alleviates symptoms but has limitations, including the challenge of balancing therapeutic effects against potential side effects, as well as limited battery life. To address these issues, adaptive DBS (aDBS) systems, which dynamically adjust stimulation parameters based on real-time physiological feedback, have attracted growing interest.

Objectives: The aim of this study was to assess the efficacy, tolerability, and safety of aDBS in patients with advanced PD over a 1-year period, using the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and Parkinson's Disease Questionnaire-39 (PDQ-39).

Methods: This prospective, single-arm study involved 19 patients who transitioned from cDBS to aDBS. Baseline assessments were conducted under cDBS, and patients were re-evaluated 1 year after switching to aDBS.

Results: Sixteen patients completed 1 year of aDBS. Significant improvements in motor function, as measured by MDS-UPDRS Part III scores in the medication-off/stimulation-on condition, were observed. Patients with severe baseline wearing-off showed greater reductions in motor fluctuation (MDS-UPDRS Part IV) scores. Younger patients showed better quality of life (PDQ-39) and activity of daily living (MDS-UPDRS Part II) scores, though overall changes were not statistically significant.

Conclusions: aDBS shows promise in managing motor symptoms in PD, particularly in patients with pronounced wearing-off and younger patients, by dynamically adjusting stimulation parameters. Although further optimization and long-term studies are necessary, these findings underscore the potential of aDBS to offer personalized treatment options for advanced PD.