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Abstract Adaptive deep brain stimulation (aDBS) is a promising therapeutic approach for subjects with Parkinson’s disease (PD) using neural signals as feedback control to adjust the level of therapy. However, the circadian fluctuation of neural signals may alter these control signals and possibly result in suboptimal therapy. We report a large retrospective cohort including 119 subjects with PD (165 hemispheres) with globus pallidus internus (GPi) and subthalamic nucleus (STN) activity recorded chronically in the home environment. Both GPi and STN activity was significantly altered by circadian rhythms. The direction of the circadian rhythm (increase versus decrease at night) depended on the frequency band in both the GPi and STN. The use of long-acting extended released dopaminergic medications significantly impacted the circadian rhythms in the GPi target. These findings demonstrate the variability of chronic circadian rhythms and suggest that aDBS will likely need to account for these patient-specific fluctuations to ensure successful implementation in real-world environments.
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