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  • Perspective
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From adaptive deep brain stimulation to adaptive circuit targeting

Nature Reviews Neurology volume 21, pages 556–566 (2025)Cite this article

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Abstract

Deep brain stimulation (DBS) substantially improves motor symptoms and quality of life in people with movement disorders such as Parkinson disease and dystonia, and it is also being explored as a treatment option for other brain disorders, including treatment-resistant obsessive–compulsive disorder, Alzheimer disease and depression. Two major developments are currently driving progress in DBS research: first, the framework of adaptive DBS, which senses brain activity to infer the momentary state of the symptoms of a patient and reacts by adapting stimulation settings, and second, the concept of connectomic DBS, which identifies brain circuits that should optimally be stimulated to reduce specific symptoms. In this Perspective, we propose a unified framework that combines these two concepts. Our approach, termed adaptive circuit targeting, decodes symptom severity from brain signals and adaptively activates the most relevant symptom-response circuits. We discuss the state of the art in the adaptive and connectomic DBS fields and the research gaps that need to be addressed to unify these concepts.

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Fig. 1: Fusing adaptive and connectomic DBS.
Fig. 2: Adaptive circuit targeting deep brain stimulation.

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Acknowledgements

The authors acknowledge the pioneering work by N. Rajamani and T. Merk in the development of this concept. A.H. was supported by the Schilling Foundation. W.-J.N. was funded by Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) — Project-ID 424778381 — TRR 295 and the European Union (ERC, ReinforceBG, 101077060). Views and opinions expressed are, however, those of the authors only and do not necessarily reflect those of the European Union or the European Research Council. Neither the European Union nor the granting authority can be held responsible for them.

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Authors and Affiliations

  1. Network Stimulation Institute, Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany

    Andreas Horn

  2. Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Andreas Horn

  3. Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

    Wolf-Julian Neumann

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  1. Andreas Horn
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The authors contributed equally to all aspects of the article.

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Correspondence to Andreas Horn or Wolf-Julian Neumann.

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Competing interests

A.H. reports lecture fees from Boston Scientific, is a consultant for Modulight.bio, was a consultant for FxNeuromodulation and Abbott in recent years, and serves as a co-inventor on a patent granted to Charité University Medicine Berlin that covers multisymptom deep brain stimulation (DBS) fibre filtering and an automated DBS parameter suggestion algorithm (patent #LU103178). W.J.N. received honoraria for consulting from INBRAIN Neuroelectronics, which is a neurotechnology company, and honoraria for talks from Medtronic, which is a manufacturer of DBS devices unrelated to this manuscript.

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Horn, A., Neumann, WJ. From adaptive deep brain stimulation to adaptive circuit targeting. Nat Rev Neurol 21, 556–566 (2025). https://doi.org/10.1038/s41582-025-01131-5

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