April 7, 2026

@michaelokun

Adaptive DBS means a system that senses brain signals in real time and adjusts stimulation automatically rather than delivering constant stimulation. Koeglsperger and colleagues describe in a new paper in Movement Disorders how adaptive deep brain stimulation is evolving and what is holding it back from widespread clinical use. Key Points: - Adaptive DBS adjusts stimulation in real time using brain signals such as beta oscillations, aiming for more precise symptom control and fewer side effects. - Early studies suggest similar or modestly improved motor outcomes compared to conventional DBS, w/ potential reductions in energy use and symptom fluctuations. - Major challenges include variability in biomarkers across individuals, complexity of programming, and uncertainty about which patients benefit most. My take: This is one of the most important next steps in DBS. We are moving from continuous stimulation to responsive stimulation, however the biology is messy and not every brain gives us a clean signal to follow. The future likely depends on combining brain signals, wearable data and patient feedback into one smarter system. Some of the studies are revealing many programming sessions necessary to see if the juice is worth the squeeze. We will need to compress that timeline. Here are 5 points that resonated w/ me: 1- Adaptive DBS shifts care toward personalization by matching stimulation to your brain activity in real time. 2- Beta signals work well for stiffness and slowness, however they do not always fully capture tremor or non-motor symptoms. 3- Not every person has a reliable signal, which means careful patient selection remains critical. 4- Benefits today appear modest, however even small gains in ON time and fewer side effects can matter a lot in daily life to an individual. 5- The future will likely combine brain signals, wearables and person input to create an optimally effective closed loop Parkinson’s care system. https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mds.70284 #fixelinstitute #michaelokun #parkinson