Circadian limbic and thalamic beta oscillations drive slow-adapting dual-threshold adaptive deep brain stimulation in Tourette syndrome

This proof-of-concept study demonstrates: (1) circadian modulation of beta rhythms in limbic and thalamic targets, supporting the feasibility of leveraging these signals for adaptive DBS; (2) that cross-target tethering is feasible (i.e. adapting stimulation in the VC/VS off of sensing in the CM-Pf and vice versa); and (3) that a dual-threshold algorithm can be configured to enable gradual transitions between maximal and minimal stimulation. The patient's observed improvements during circadian-driven aDBS compared with cDBS suggest potential clinical benefit, warranting testing in larger samples.