Jan 21, 2026
Dr. Johannes Busch on the First Chronic Trial of Adaptive DBS
Adaptive deep brain stimulation is one of the most promising developments in the treatment of Parkinson’s disease. Instead of continuous stimulation with fixed, preset parameters (cDBS), Dual Threshold adaptive DBS (aDBS) adjusts the stimulation intensity in real time to a measured brain signal (usually STN beta activity). A new clinical study led by Dr. Johannes Busch from Charité – Universitätsmedizin Berlin, published in npj Parkinson’s Disease, reports on the first clinical trial of this system in everyday use. Together with lead author Prof. Andrea Kühn and colleagues, Dr. Busch investigated how patients respond to adaptive stimulation over several weeks and which programming strategies support stable and effective treatment as part of the ReTune project consortium.
In this interview, we talk to Dr. Busch about the motivation behind the study, the challenges of implementing adaptive DBS in a clinical setting, and the potential of personalized stimulation strategies for the future of Parkinson’s therapy.
What motivated you and your team to conduct the first chronic clinical evaluation of adaptive deep brain stimulation?
Adaptive DBS had shown a lot of promise in short experimental studies, but clinical-grade aDBS systems have only been introduced recently. We really did not know how it would perform in everyday clinical use. Patients live with fluctuating symptoms over weeks and months, not just during lab sessions. With the system becoming commercially available, we felt it was important to understand whether adaptive stimulation is actually feasible, helpful, and manageable in routine care. We also wanted to learn what clinicians need to pay attention to when programming it.
What were the most important findings of your study in terms of clinical benefits?
We found that adaptive DBS can improve patients’ overall well-being compared to optimized conventional stimulation, even though the effects varied between individuals. Some patients experienced improved slowness of movements without an increase in dyskinesia, which is encouraging. Importantly, most patients who completed the setup chose to stay on adaptive stimulation. At the same time, the benefits were not universal, which highlights the need for careful patient selection. It is important, though, to highlight that our study examined a limited number of patients and represents a first step toward a larger clinical trial, which we hope will address some of the open questions we cannot yet fully answer.
What challenges did you encounter in terms of programming, and what strategies do you recommend based on your findings?
As expected, programming adaptive DBS turned out to be more complex and time-consuming than standard DBS. Brain signals can vary considerably over time and can be influenced by several factors, including body motions, the electric activity of the heart and other artifacts, which makes setting aDBS parameters challenging. We learned that long-term recordings in daily life are essential and more informative than short in-clinic measurements. Tracking patients’ symptoms alongside brain signals via a smartphone app not only allowed us to collect clinical endpoint data, but may also improve the clinical interpretation of brain signals, which in turn could benefit aDBS programming. In our study we propose a stepwise programming approach that emphasizes these aspects.
How do you assess the significance of the study? For which patients is dual-threshold aDBS suitable, and how could it influence future treatment strategies for Parkinson’s disease?
This study shows that adaptive DBS can work outside the lab and may offer added value for selected patients with persistent motor fluctuations despite optimized conventional DBS. From what we know so far, it is probably not a replacement for standard stimulation, but rather an additional option for specific clinical situations. Our results also highlight that adaptive DBS requires experience and time, so it is best implemented in specialized centers. Looking ahead, we see this as an important step toward more personalized and flexible DBS therapies in Parkinson’s disease.
Thank you very much for the interview.
© Pictures: TRR 295 Retune
