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. 2022 Apr 20;12:6493. doi: 10.1038/s41598-022-10130-1

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© The Author(s) 2022

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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The “dam model” of basal ganglia functions²⁸ and the expected effects of STN-DBS using constant and adaptive paradigms. (A) Normal state: In the healthy state, only the selected motor plans pass over the threshold of the internal pallidal (GPi) function, causing the intended movement, while other plans are blocked. (B) Parkinson’s disease (PD) condition: In parkinsonism, the threshold of the GPi function is elevated, which causes the blockade of all motor plans, resulting in hypokinesia. (C) cDBS in PD: Constant deep brain stimulation (cDBS) delivers constant stimulation to the subthalamic nucleus (STN), continuously lowers the threshold of the GPi function, and allows the motor plans to cause the intended movements. (D) STN-β aDBS in PD: Adaptive DBS (aDBS) is modulated by β activity in the STN, which is a biomarker of hypokinesia. STN-β aDBS delivers stimulation when hypokinetic state occurs, temporary lowers the threshold of the GPi function, and increases the likelihood for selection of motor plans during this time window. (E) M1-γ2 aDBS in PD: aDBS is modulated by γ2 activity in the primary motor cortex (M1), which is a biomarker of movement-related activity. M1-γ2 aDBS delivers stimulation when motor plans are presupposed being generated in the M1, lowers the threshold of the GPi function, and increases the likelihood for selection of motor plans in this time window.