Objective:

To determine whether adaptive/closed-loop deep brain stimulation (aDBS) confers superior motor benefit over conventional continuous DBS (cDBS) in Parkinson’s disease (PD).

Background:

cDBS delivers constant stimulation that can miss fluctuating needs in Parkinson’s disease, whereas emerging aDBS dynamically adjusts output using neural biomarkers but has been tested only in small, heterogeneous trials with mixed results. It is not clear whether adaptive stimulation offers superior motor benefit and reduced energy delivery compared with standard continuous DBS.

Design/Methods:

A preregistered systematic review and meta-analysis (PROSPERO CRD420251026241) searched MEDLINE, Embase and CENTRAL to May 2025 for randomised crossover or parallel trials directly comparing aDBS with cDBS. Data were pooled with a random-effects model, expressed as standardised mean differences (SMD) in Unified Parkinson’s Disease Rating Scale part III (UPDRS-III/MDS-UPDRS-III) scores. Baseline descriptive statistics were synthesised across trials using sample-size–weighted means ± SD.

Results:

Four trials (N = 63) met inclusion criteria, including the multicentre ADAPT-PD trial. Across participants, mean age was 59.5 ± 8.2 years, disease duration 12.7 ± 6.4 years, levodopa-equivalent daily dose 672 ± 441 mg/day, and baseline UPDRS-III off medication 40.4 ± 6.8. Pooled analysis showed no significant difference between aDBS and cDBS for acute motor improvement (SMD = –0.12, 95 % CI –0.46 to 0.23; Z = –0.66, p = 0.51). Heterogeneity was moderate (I² = 50 %, τ² = 0.084). Five small single-centre studies favoured aDBS, whereas the ADAPT-PD trial modestly favoured cDBS (SMD = 0.36, 95 % CI 0.04 to 0.68).

Conclusions:

Current randomised evidence does not demonstrate a clinically meaningful short-term motor advantage of aDBS over cDBS in PD. Longer trials using harmonised outcome sets are needed to establish whether these motor improvement gains translate into durable clinical benefit, improved quality of life and extended device longevity.