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Adaptive deep brain stimulation (DBS) promises to revolutionize the treatment of Parkinson disease with neuromodulation, and regulatory approval has enabled its use in clinical practice. This Clinical Outlook considers the principles behind adaptive DBS, current clinical recommendations and practical considerations in its implementation, as well as remaining challenges.
Little, S. et al. Adaptive deep brain stimulation in advanced Parkinson disease. Ann. Neurol. 74 , 449–457 (2013).
Kühn, A. A., Kupsch, A., Schneider, G.-H. & Brown, P. Reduction in subthalamic 8–35 Hz oscillatory activity correlates with clinical improvement in Parkinson’s disease. Euro. J. Neurosci. 23 , 1956–1960 (2006).
Bronte-Stewart, H. M. et al. Long-term personalized adaptive deep brain stimulation in Parkinson disease - a nonrandomized clinical trial. JAMA Neurol. 82 , 1171–1180 (2025).
Busch, J. L. et al. Chronic adaptive deep brain stimulation for Parkinson’s disease: clinical outcomes and programming strategies. npj Parkinsons Dis. 11 , 264 (2025).
Feldmann, L. K. et al. Electrophysiological changes in the acute phase after deep brain stimulation surgery. Brain Stimul. 18 , 1579–1586 (2025).
Oehrn, C. R. et al. Chronic adaptive deep brain stimulation versus conventional stimulation in Parkinson’s disease: a blinded randomized feasibility trial. Nat. Med. 30 , 3345–3356 (2024).
Swinnen, B. E. K. S., Hoy, C. W. & Little, S. J. Towards adaptive deep brain stimulation for non-motor symptoms in Parkinson’s disease? Mov. Disord. 40 , 1759–1777 (2025).
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E.F. and A.A.K. are supported by the German Research Foundation (Deutsche Forschungsgemeinschaft) – Project ID 424778381 – TRR 295.
Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
Neurocure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany
A.A.K. has received honoraria from Bial, Boston Scientific and Medtronic. E.F. declares no competing interests.
Florin, E., Kühn, A.A. Adaptive deep brain stimulation in Parkinson disease: clinical implementation and outlook. Nat Rev Neurol (2026). https://doi.org/10.1038/s41582-026-01239-2