Directional Adaptive Deep Brain Stimulation: An Initial Report of Safety, Tolerability, and Effectiveness

Abstract

Abstract Background Adaptive deep brain stimulation (aDBS) is a safe and effective therapy for people with Parkinson's disease (PWP). Utilization of directional aDBS has not been specifically evaluated. Objectives The goal is to report the first data on the safety, tolerability, and preliminary effectiveness of chronic, directional aDBS in PWP. Methods A supplemental cohort from the Adaptive DBS Algorithm for Personalized Therapy in Parkinson's Disease Trial received directional aDBS. Participants who were previously receiving stable continuous directional DBS (dDBS) completed an open‐label evaluation of two aDBS modes. Results Seventeen participants were enrolled, with 15 completing directional aDBS evaluation. The prespecified primary endpoint and post hoc success criterion was met for both directional aDBS modes. On‐time without troublesome dyskinesia was increased, with a median of 1.2 hours/day in directional dual threshold aDBS mode. Stimulation‐related events were similar between dDBS and directional aDBS. All 15 participants chose to continue with directional aDBS chronically. Conclusions Preliminary data indicates chronic directional aDBS is feasible, tolerable, effective, and safe in PWP. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.