Patient perspectives on closed-loop deep brain stimulation: An exploratory study

Deep Brain Stimulation (DBS) technologies have expanded to include closed-loop DBS (CL-DBS), which adjusts stimulation parameters in real-time. Potential advantages in the treatment of movement disorders, such as Parkinson Disease (PD), include improved motor symptom control, reduced side effects, and decreased energy consumption. However, the successful implementation of novel technologies depends on patient acceptance. The present study thereby aimed to explore patient awareness and understanding of CL-DBS among patients treated with or being considered for DBS, and examine perceptions, expectations, and concerns among PD patients with CL-DBS compatible devices. An exploratory cross-sectional mixed-methods design was used. Data were collected through an online questionnaire informed by the Unified Theory of Technology Acceptance and Use of Technology (UTAUT). The questionnaire combined closed-ended items analyzed descriptively and open-ended responses analyzed thematically. In total, 79 participants filled out the questionnaire. Out of them, seven participants with Parkinson Disease and the Medtronic Percept TM implant completed the extended CL-DBS section. The broader sample showed limited awareness of CL-DBS, with many participants reporting little or no prior knowledge of the distinction between open and closed systems. The ‘Extended Subgroup' showed expectations of symptom improvement, including better symptom control, fewer off-periods, improved daily functioning, and reduced side effects. The findings suggest that perceived symptom improvement and performance expectancy may be important factors shaping patient acceptance of CL-DBS. Simultaneously, limited awareness highlights the need for clear patient education and communication strategies, as CL-DBS moves toward broader clinical implementation.