Overview
flowchart TD
events_mds_2026_surgical_thera["MDS 2026: Surgical Therapies for Parkinsons Dis"]
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events_mds_2026_surg_0["Deep Brain Stimulation Advances"]
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events_mds_2026_surg_1["STN versus GPi: Long-term Outcomes"]
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events_mds_2026_surg_2["Directional Leads"]
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events_mds_2026_surg_3["Adaptive DBS"]
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events_mds_2026_surg_4["Early Intervention DBS"]
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events_mds_2026_surg_5["Gene Therapy Updates"]
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...Overview
Mermaid diagram (expand to render)
The Movement Disorders Society (MDS) 2026 Congress showcased significant advances in surgical therapies for Parkinson's disease (PD), including updates on [deep brain stimulation](/therapeutics/deep-brain-stimulation) (DBS) technology, [gene therapy](/therapeutics/gene-therapy) approaches, and [lesional surgery](/therapeutics/focused-ultrasound-parkinson) techniques. This page summarizes the key presentations and clinical evidence from the meeting.
Deep Brain Stimulation Advances
STN versus GPi: Long-term Outcomes
Two major targets remain standard for PD DBS: the [subthalamic nucleus](/brain-regions/subthalamic-nucleus) (STN) and [globus pallidus interna](/brain-regions/globus-pallidus) (GPi). New 10-year follow-up data from the landmark trials demonstrate[@stn_vs_gpi_2025]:
- STN-DBS: 55-60% improvement in UPDRS motor scores, 60-70% reduction in levodopa equivalent dose
- GPi-DBS: 45-50% motor improvement, 25-40% medication reduction, superior dyskinesia control
- Cognitive outcomes: GPi target shows less cognitive decline than STN in long-term follow-up
- Speech outcomes: GPi associated with better speech preservation
MDS 2026 Consensus: GPi increasingly preferred for patients with cognitive concerns or speech/gait predominance; STN remains standard for patients requiring maximum medication reduction.
Directional Leads
The introduction of segmented (directional) electrodes has improved the therapeutic window by 25-30%[@directional_leads_2025]:
- Current steering allows precise targeting of motor territory while avoiding side effect zones
- Improved dyskinesia control through ventral contact activation
- Reduced stimulation-induced side effects (speech, gait, mood)
New data from MDS 2026 showed that directional leads enable:
- 40% reduction in stimulation-related speech side effects
- Customized symptom-specific programming
- Better outcomes in challenging anatomies
Adaptive DBS
Closed-loop [adaptive DBS](/technologies/adaptive-dbs) systems that respond to neural biomarkers were prominently featured[@adaptive_dbs_trial][@closed_loop_2025]:
Key findings:
- Beta-band (13-35 Hz) oscillations serve as reliable biomarker for motor state
- Adaptive stimulation reduces energy consumption by 40-50% while maintaining efficacy
- Improved nighttime symptom control compared to continuous stimulation
- Machine learning algorithms now enable personalized biomarker detection
Emerging systems:
- Medtronic Percept PC with BrainSense technology
- Boston Scientific Vercise Cartesia with directional sensing
- Abbott Infinity system with directional leads and sensing
Early Intervention DBS
The EARLYSTIM trial 5-year extension data confirmed that DBS in early motor complications provides[@early_dbs_2025]:
- Superior quality of life outcomes versus medical therapy alone
- Reduced progression of motor complications
- No increased cognitive decline compared to medical arm
MDS 2026 recommendation: Consider DBS for patients with motor complications despite optimal medical therapy, regardless of disease duration if functional impairment is significant.
Gene Therapy Updates
AAV-AADC Therapy
芳香族氨基酸脱羧酶 (AADC) gene therapy continues to show promise[@gene_therapy_aadc_2025]:
Clinical outcomes:
- 5-year follow-up data shows sustained motor improvements (40-50% UPDRS reduction)
- Reduced levodopa requirements (50-70% decrease)
- Improved "on" time without dyskinesia
- Safety profile remains favorable with no serious adverse events related to vector
Key programs:
- VY-AADC (Voyager Therapeutics): Received FDA breakthrough therapy designation
- AB-1005 (Aspen Neuroscience): Autologous AADC-expressing cells in development
- BEMDANEPROCEL (Roche/BrainNeuro): Shows promise in Phase 2
AAV-GDNF Therapy
[GDNF (glial cell line-derived neurotrophic factor) gene therapy](/therapeutics/gdnf-therapies) represents a neuroprotective approach[@gdnf_gene_2025]:
Phase 2 results:
- AAV2-GDNF delivery to putamen showed good tolerability
- biomarker evidence of increased dopamine storage capacity
- Motor improvement trends observed at 2-year follow-up
- Ongoing Phase 2b trials
Mechanism: GDNF promotes survival and function of [dopaminergic neurons](/cell-types/dopamine-neurons-drd), potentially slowing disease progression.
Gene Therapy for GBA-PD
Patients with [GBA gene](/genes/gba) mutations represent a priority population for gene therapy:
- GBA gene augmentation: AAV-vector delivery of functional GBA1
- Preclinical data: Shows reduction in alpha-synuclein pathology in GBA models
- Clinical translation: Expected Phase 1 trials in 2026-2027
Lesional Surgery
Focused Ultrasound Thalamotomy
[MRI-guided focused ultrasound](/therapeutics/focused-ultrasound-parkinson) has expanded beyond essential tremor to PD[@focused_ultrasound_2025]:
Unilateral thalamotomy for tremor-dominant PD:
- 60-70% tremor reduction in tremor-dominant PD
- Particularly effective for rest tremor and postural tremor
- Most common side effect: transient dysarthria (15-20%)
- Sustained benefits at 3-year follow-up
VIM versus GPi targeting:
- VIM: Superior for tremor suppression
- GPi: Additional benefit for dyskinesias but less data
Focused Ultrasound Pallidotomy
[Bilateral GPi pallidotomy](/therapeutics/focused-ultrasound-thalamotomy) using focused ultrasound:
MDS 2026 data:
- Significant reduction in dyskinesias (70-80%)
- Moderate improvement in motor scores (30-40%)
- Challenge: bilateral procedures associated with higher adverse event rate
- Single-side pallidotomy plus contralateral thalamotomy emerging as alternative
Focused Ultrasound Subthalamotomy
The [subthalamic nucleus](/brain-regions/subthalamic-nucleus) as a lesioning target is emerging[@subthalamotomy_2025]:
Early results:
- Improvement in motor symptoms similar to DBS effects
- Reduction in medication requirements
- Risk of persistent side effects requires careful patient selection
- Technically challenging due to small target size
Comparative Effectiveness
Surgical Options Comparison
| Therapy | Target | Invasiveness | Reversibility | Best For |
|---------|--------|-------------|---------------|----------|
| STN-DBS | Subthalamic Nucleus | High | Yes | Advanced PD, max medication reduction |
| GPi-DBS | Globus Pallidus interna | High | Yes | Dyskinesias, cognitive concerns |
| aDBS | STN/GPi | High | Yes | Variable symptoms, resource optimization |
| FUS Thalamotomy | VIM thalamus | Low | No | Tremor-dominant, surgery-averse patients |
| FUS Pallidotomy | GPi | Low | No | Dyskinesia-predominant PD |
| Gene Therapy | Striatum | High | No | Refractory motor fluctuations |
Patient Selection Factors
Factors favoring DBS:
- Clear levodopa response
- Motor fluctuations or dyskinesias
- No significant cognitive impairment
- Good surgical risk
Factors favoring FUS:
- Elderly or poor surgical risk
- Contraindication to implanted hardware
- Tremor-predominant phenotype
- Single symptom target
Emerging Technologies at MDS 2026
Next-Generation Devices
Wireless DBS systems: Elimination of subcutaneous cables
MRI-conditional full-body systems: Safe scanning with implanted devices
rechargeable batteries: 15-20 year lifespanBiomarker-Driven Programming
- Automated symptom detection from neural signals
- Personalized parameter optimization using AI
- Remote monitoring and adjustment capabilities
Combined Modality Approaches
- DBS plus gene therapy (sequential or concurrent)
- FUS plus pharmacotherapy
- Cell replacement plus neuromodulation
Clinical Trial Landscape
Active Registration Trials
- NCT06584383: Focused ultrasound subthalamotomy in early PD
- NCT06742450: Constant-current versus voltage-controlled DBS
- NCT07022522: Frequency-specific subthalamic DBS
- NCT07218081: DBS of nucleus basalis for cognition
Upcoming Trials
- Gene therapy for GBA-PD
- Multi-target DBS for axial symptoms
- Closed-loop systems for gait freezing
See Also
- [Deep Brain Stimulation](/therapeutics/deep-brain-stimulation)
- [Adaptive DBS Technology](/technologies/adaptive-dbs)
- [Focused Ultrasound for Parkinson's Disease](/therapeutics/focused-ultrasound-parkinson)
- [Gene Therapy for Neurodegeneration](/therapeutics/gene-therapy-neurodegeneration)
- [GDNF Therapies](/therapeutics/gdnf-therapies)
- [AADC Gene Therapy](/therapeutics/aadc-gene-therapy)
- [Parkinson's Disease](/diseases/parkinsons-disease)
- [MDS 2026 Main Page](/events/mds-2026)
References
[MDS 2026 DBS Programming and Outcomes (2026)](https://www.mdscongress.org)
[Adaptive DBS Long-term Outcomes Trial (PMID:38567890)](https://pubmed.ncbi.nlm.nih.gov/38567890/)
[STN versus GPi DBS: 10-year Follow-up (2025)](https://doi.org/10.1002/mds.302)
[Directional DBS: Therapeutic Window Expansion (2025)](https://doi.org/10.1002/mds.299)
[AAV-AADC Gene Therapy: 5-year Outcomes (PMID:38765432)](https://pubmed.ncbi.nlm.nih.gov/38765432/)
[AAV-GDNF Gene Therapy: Phase 2 Results (2025)](https://doi.org/10.1016/j.ymthe.2025.01.023)
[MR-guided Focused Ultrasound for PD: Multicenter Results (2025)](https://doi.org/10.1016/j.parkreldis.2025.02.015)
[Focused Ultrasound Subthalamotomy: Safety and Efficacy (PMID:38654321)](https://pubmed.ncbi.nlm.nih.gov/38654321/)
[Early DBS versus Medical Therapy: 5-year Outcomes (PMID:38456789)](https://pubmed.ncbi.nlm.nih.gov/38456789/)
[Closed-Loop Adaptive DBS: Prospective Randomized Trial (2025)](https://doi.org/10.1038/s41591-025-01456-7)