Will adaptive deep brain stimulation for Parkinson's disease become a real option soon? A Delphi consensus study

Matteo Guidetti¹, Tommaso Bocci^{1

2}, Marta De Pedro Del Álamo³, Guenther Deuschl⁴, Alfonso Fasano^{5

6

7

8}, Raul Martinez-Fernandez^{3

9}, Carmen Gasca-Salas^{3

9}, Clement Hamani^{10

11

12}, Joachim K Krauss¹³, Andrea A Kühn^{14

15

16

17

18}, Patricia Limousin¹⁹, Simon Little²⁰, Andres M Lozano^{5

6

21}, Natale V Maiorana¹, Sara Marceglia²², Michael S Okun²³, Serena Oliveri^{1

2}, Jill L Ostrem²⁰, Emma Scelzo², Alfons Schnitzler^{24

25}, Philip A Starr^{26

27

28}, Yasin Temel²⁹, Lars Timmermann³⁰, Gerd Tinkhauser³¹, Veerle Visser-Vandewalle³², Jens Volkmann³³, Alberto Priori^{1

2}

Affiliations

¹ Department of Health Sciences, "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy.
² Clinical Neurology Unit, Department of Health Sciences, "Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo", University of Milan, Milan, Italy.
³ HM CINAC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.
⁴ Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel and Christian Albrechts-University of Kiel Kiel Germany, Kiel, Germany.
⁵ Krembil Research Institute, University Health Network, Toronto, ON, Canada.
⁶ CRANIA Center for Advancing Neurotechnological Innovation to Application, University of Toronto, Toronto, ON, Canada.
⁷ KITE, University Health Network, Toronto, ON, Canada.
⁸ Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Division of Neurology, University of Toronto, Toronto, ON, Canada.
⁹ Instituto Carlos III, CIBERNED, Madrid, Spain.
¹⁰ Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹¹ Harquail Centre for Neuromodulation, Toronto, ON, Canada.
¹² Department of Surgery, University of Toronto, Toronto, ON, Canada.
¹³ Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
¹⁴ Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
¹⁵ Bernstein Center for Computational Neuroscience, Humboldt-Universität, Berlin, Germany.
¹⁶ NeuroCure, Exzellenzcluster, Charité-Universitätsmedizin Berlin, Berlin, Germany.
¹⁷ DZNE, German Center for Neurodegenerative Diseases, Berlin, Germany.
¹⁸ Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.
¹⁹ Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK.
²⁰ Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA.
²¹ Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
²² Department of Health Sciences, "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy. sara.marceglia@unimi.it.
²³ Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.
²⁴ Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
²⁵ Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
²⁶ UCSF Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
²⁷ UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
²⁸ UCSF Department of Physiology, University of California San Francisco, San Francisco, CA, USA.
²⁹ Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.
³⁰ Department of Neurology, University Hospital of Marburg, Marburg, Germany.
³¹ Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
³² Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
³³ Department of Neurology, University Hospital Würzburg, Würzburg, Germany.

PMID: 40325017
PMCID: PMC12052990
DOI: 10.1038/s41531-025-00974-5

Will adaptive deep brain stimulation for Parkinson's disease become a real option soon? A Delphi consensus study

Matteo Guidetti et al. NPJ Parkinsons Dis. 2025.

. 2025 May 5;11(1):110.

doi: 10.1038/s41531-025-00974-5.

Authors

Affiliations

¹ Department of Health Sciences, "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy.
² Clinical Neurology Unit, Department of Health Sciences, "Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo", University of Milan, Milan, Italy.
³ HM CINAC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.
⁴ Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel and Christian Albrechts-University of Kiel Kiel Germany, Kiel, Germany.
⁵ Krembil Research Institute, University Health Network, Toronto, ON, Canada.
⁶ CRANIA Center for Advancing Neurotechnological Innovation to Application, University of Toronto, Toronto, ON, Canada.
⁷ KITE, University Health Network, Toronto, ON, Canada.
⁸ Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Division of Neurology, University of Toronto, Toronto, ON, Canada.
⁹ Instituto Carlos III, CIBERNED, Madrid, Spain.
¹⁰ Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹¹ Harquail Centre for Neuromodulation, Toronto, ON, Canada.
¹² Department of Surgery, University of Toronto, Toronto, ON, Canada.
¹³ Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
¹⁴ Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
¹⁵ Bernstein Center for Computational Neuroscience, Humboldt-Universität, Berlin, Germany.
¹⁶ NeuroCure, Exzellenzcluster, Charité-Universitätsmedizin Berlin, Berlin, Germany.
¹⁷ DZNE, German Center for Neurodegenerative Diseases, Berlin, Germany.
¹⁸ Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.
¹⁹ Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK.
²⁰ Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA.
²¹ Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
²² Department of Health Sciences, "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy. sara.marceglia@unimi.it.
²³ Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.
²⁴ Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
²⁵ Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
²⁶ UCSF Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
²⁷ UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
²⁸ UCSF Department of Physiology, University of California San Francisco, San Francisco, CA, USA.
²⁹ Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.
³⁰ Department of Neurology, University Hospital of Marburg, Marburg, Germany.
³¹ Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
³² Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
³³ Department of Neurology, University Hospital Würzburg, Würzburg, Germany.

PMID: 40325017
PMCID: PMC12052990
DOI: 10.1038/s41531-025-00974-5

Abstract

While conventional deep brain stimulation (cDBS) treatment delivers continuous electrical stimuli, new adaptive DBS (aDBS) technology provides dynamic symptom-related stimulation. Research data are promising, and devices are already available, but are we ready for it? We asked leading DBS experts worldwide (n = 21) to discuss a research agenda for aDBS research in the near future to allow full adoption. A 5-point Likert scale questionnaire, along with a Delphi method, was employed. In the next 10 years, aDBS will be clinical routine, but research is needed to define which patients would benefit more from the treatment; second, implantation and programming procedures should be simplified to allow actual generalized adoption; third, new adaptive algorithms, and the integration of aDBS paradigm with new technologies, will improve control of more complex symptoms. Since the next years will be crucial for aDBS implementation, the research should focus on improving precision and making programming procedures more accessible.

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Conflict of interest statement

Competing interests: M.G., N.V.M., S.O., T.B., E.S., Y.T., C.H., and P.L. declare no conflict of interest. M.A.P is a consultant for Boston Scientific, Insightec, Medtronic, and Abbott. She has received reimbursement of travel expenses to attend scientific meetings by Palex, Boston Scientific, and Medtronic. She has received speaker honoraria from Palex. G.D. has served as a consultant for Boston Scientific and Cavion and as a DSMB member for Functional Neuromodulation. He has received royalties from Thieme Publishers and funding from the German Research Council (SFB 1261, T1). A.F. has received payments as a consultant and/or speaker from Abbott, Boston Scientific, Ceregate, Inbrain Neuroelectronics, Medtronic, and Iota, and has received research support from Boston Scientific, Medtronic. R.M.F. has received speaker honoraria from the Spanish Neurological Society research foundation, Insightec, Palex, Bial, and Zambon; has a consulting agreement with Treefrog Therapeutics; has received reimbursement of travel expenses to attend scientific meetings by Palex, Zambon, the International Parkinson and Movement Disorder Society, the IAPDRD, and the World Parkinson’s Congress; and has received research funding from Instituto de Salud Carlos III, Madrid, Spain for health research projects (PI21 Proyectos de Investigacion en Salud, AES 2021). C.G.S. has received lecture honoraria from Exeltis, Zambon, Palex, Insightec, Fundación ACE, Società Italiana Parkinson e Disordini del Movimento, and Asociación Madrileña de Neurología, and reimbursement of travel expenses to attend scientific conferences from Boston Scientific and Esteve. J.K.K. is a consultant to Medtronic, Boston Scientific, aleva, and Inomed. A.A.K. is a consultant to Medtronic, Boston Scientific, and Teva. S.L. is a consultant for Iota Biosciences and has previously received honorarium from Medtronic. S.L.’s research is supported by NINDS NIH grants R01NS131405, K23NS120037, and Wellcome Discovery Award 226645/Z/22/Z. A.M.L. is a consultant to Abbott, Boston Scientific, Insightec, Medtronic, and Functional Neuromodulation (Scientific Director). M.S.O. serves as Medical Advisor in the Parkinson’s Foundation, and has received research grants from NIH, Parkinson’s Foundation, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation. M.S.O.’s research is supported by: R01 NS131342, NIH R01 NR014852, R01NS096008, UH3NS119844, U01NS119562. M.S.O. is PI of the NIH R25NS108939 Training Grant. M.S.O. has received royalties for publications with Hachette Book Group, Demos, Manson, Amazon, Smashwords, Books4Patients, Perseus, Robert Rose, Oxford, and Cambridge (movement disorders books). M.S.O. is an associate editor for the New England Journal of Medicine, Journal Watch Neurology, and JAMA Neurology. M.S.O. has participated in CME and educational activities (past 12–24 months) on movement disorders sponsored by WebMD/Medscape, RMEI Medical Education, American Academy of Neurology, Movement Disorders Society, Mediflix, and by Vanderbilt University. The institution and not M.S.O. receives grants from industry. M.S.O. has participated as a site PI and/or co-I for several NIH, foundation, and industry-sponsored trials over the years but has not received honoraria. Research projects at the University of Florida receive device and drug donations. J.L.O. received consulting payments from Abbott, Acorda, Jazz, Adamas, AcureX, and Aspen as well as research or training grants from Biogen, Boston Scientific, Medtronic, Neuroderm, Runelabs, AbbVie, Merz, Amneal, and Acadia. A.S. received consulting fees from Abbott, Zambon, and AbbVie, and speaker honoraria from bsh Medical communication, Abbott, Kyowa Kirin, Novartis, AbbVie, Alexion, and GE Healthcare. The institution of AS, not AS personally, received funding by the Deutsche Forschungsgemeinschaft, the Brunhilde Moll Foundation, and Abbott. P.A.S. is compensated for time spent on the data safety and monitoring board for Neuralink, Inc. L.T. received occasional payments as a consultant for Boston Scientific, L.T. received honoraria as a speaker on symposia sponsored by Boston Scientific, AbbVIE, Novartis, Neuraxpharm, Teva, the Movement Disorders Society, and DIAPLAN. The institution of L.T., not L.T. personally, received funding from Boston Scientific, the German Research Foundation, the German Ministry of Education and Research, the Otto-Loewi-Foundation, and the Deutsche Parkinson Vereinigung. Neither L.T. nor any member of his family holds stocks, stock options, patents, or financial interests in any of the above-mentioned companies or their competitors. L.T. serves as the president of the German Neurological Society without any payment or any income. G.T. received financial support from Boston Scientific and Medtronic; research agreement with RuneLabs and Medtronic not related to the present work. V.V.V. received occasional payments as a consultant or speaker on symposia from Boston Scientific and Medtronic. J.V. reports grants and personal fees from Medtronic, grants and personal fees from Boston Scientific, and personal fees from Abbott outside the submitted work. J.V. was supported by the German Research Foundation (DFG, Project-ID424778381, TRR 295)—J.V. received consulting and lecture fees from Boston Scientific, Medtronic, and Newronika. Research grants from the German Research Foundation, the German Ministry of Research and Education, Boston Scientific, and Medtronic. Lecture Honoraria from UCB, Zambon, and Abbott. A.P. and S.M. are founders and shareholders of Newronika Spa, Italy.

Figures

**Fig. 1. Percentage of agreement for the 21 statements on the technical aspects of adaptive DBS (Statements 1–21) among the Delphi Panel members, as a result of the third round.**
A consensus was reached for Statement 1 (80% of the responses fell in the response label “Agree”), Statement 3 (85% of the responses fell in the response label “Strongly Disagree”), Statement 8 (80% of the responses fell in the response label “Strongly Agree”), Statement 14 (90% of the responses fell in the response label “Undecided”), Statement 15 (90% of the responses fell in the response label “Undecided”), Statement 18 (85% of the responses fell in the response label “Undecided”), and Statement 20 (90% of the responses fell in the response label “Agree”). DBS Deep Brain Stimulation, S statement.

**Fig. 2. Percentage of agreement for the 21 statements on the clinical aspects of adaptive DBS (Statement 22–42) among the Delphi Panel members, as a result of the third round.**
A consensus was reached for Statement 22 (85% of the responses fell in the response label “Agree”), Statement 25 (85% of the responses fell in the response label “Agree”), Statement 30 (90% of the responses fell in the response label “Agree”), Statement 31 (95% of the responses fell in the response label “Agree”), Statement 32 (90% of the responses fell in the response label “Agree”), Statement 35 (80% of the responses fell in the response label “Agree”), Statement 37 (80% of the responses fell in the response label “Agree”), and Statement 38 (80% of the responses fell in the response label “Undecided”). DBS Deep Brain Stimulation, S statement.

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Update of

Adaptive Deep Brain Stimulation in Parkinson's Disease: A Delphi Consensus Study.
Guidetti M, Bocci T, De Pedro Del Álamo M, Deuschl G, Fasano A, Fernandez RM, Gasca-Salas C, Hamani C, Krauss JK, Kühn AA, Limousin P, Little S, Lozano AM, Maiorana NV, Marceglia S, Okun MS, Oliveri S, Ostrem JL, Scelzo E, Schnitzler A, Starr PA, Temel Y, Timmermann L, Tinkhauser G, Visser-Vandewalle V, Volkmann J, Priori A. Guidetti M, et al. medRxiv [Preprint]. 2024 Aug 26:2024.08.26.24312580. doi: 10.1101/2024.08.26.24312580. medRxiv. 2024. Update in: NPJ Parkinsons Dis. 2025 May 5;11(1):110. doi: 10.1038/s41531-025-00974-5. PMID: 39252901 Free PMC article. Updated. Preprint.

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Will adaptive deep brain stimulation for Parkinson's disease become a real option soon? A Delphi consensus study

Affiliations

Will adaptive deep brain stimulation for Parkinson's disease become a real option soon? A Delphi consensus study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Update of

References