Deep brain stimulation (DBS) is an established therapy for advanced Parkinson’s disease and holds promise for a range of other neuropsychiatric disorders. Conventional DBS (cDBS) delivers continuous electrical stimulation with fixed parameters, disrupting neural circuits regardless of fluctuations in patients’ symptoms or brain states. This lack of specificity can result in side effects and diminished therapeutic efficacy over time. Recent advances highlight the potential of adaptive DBS (aDBS), which dynamically adjusts stimulation parameters in real time based on peripheral and/or neural feedback signals, providing more precise and state-dependent modulation of brain activity.

In this talk, I will present several projects demonstrating that aDBS guided by neural recordings can achieve equal or superior improvements in motor control compared to continuous high-frequency stimulation. Specifically, aDBS enhances hand-reaching performance by precisely modulating neural dynamics—suppressing pathological brain activity while preserving neural patterns essential for normal function. In contrast, cDBS indiscriminately suppresses subthalamic nucleus (STN) activity across frequency bands, even in the absence of pathological oscillations. I will also discuss tailored aDBS protocols designed to restore physiological neural functions by selectively suppressing pathological oscillations while maintaining healthy rhythms during walking and sleep. Such approaches show promise in improving gait and sleep disturbances—symptoms that remain inadequately addressed by current therapies, including dopaminergic medications and standard DBS.