This prospective cohort study found that total electrical energy delivered (TEED) and programming parameters after subthalamic nucleus DBS differ by Parkinson's motor subtype, with tremor-dominant patients requiring the highest stimulation energy, followed by PIGD and mixed subtypes.

Findings support subtype-specific DBS programming to improve clinical efficacy and energy efficiency (battery life and device management), but the study offers limited direct insight for pharmacological target discovery or neuroprotective strategies.

BACKGROUND: The total electrical energy delivered (TEED) reflects overall stimulation intensity in Parkinson's disease (PD) after deep brain stimulation (DBS). Exploring subtype-related differences may help optimize individualized programming strategies. OBJECTIVE: To compare TEED and programming parameters among PD motor subtypes following subthalamic nucleus DBS (STN-DBS). METHODS: This prospective cohort study included 39 PD patients who underwent STN-DBS between 2018 and 2024. Patients were classified as tremor-dominant (TD), postural instability/gait disorder (PIGD), or mixed subtypes based on preoperative MDS-UPDRS II/III scores. They were followed longitudinally for a maximum of 6 years. Voltage, pulse width, frequency, and impedance were recorded to calculate TEED. Longitudinal changes and between-subtype differences were analyzed using linear mixed-effects models. RESULTS: TEED increased significantly over time (P < 0.001). Compared with the mixed subtype, TD patients exhibited the highest TEED (P < 0.001), followed by PIGD (P = 0.048). Relative to mixed, TD patients showed higher frequency, shorter pulse width, and lower impedance; PIGD showed shorter pulse width, lower impedance, and reduced frequency. Postoperative levodopa equivalent daily dose (LEDD) was higher in PIGD, while no LEDD difference was observed between TD and mixed groups. Activities of daily living (ADL) scores did not differ across subtypes. CONCLUSION: STN-DBS stimulation energy requirements and programming parameters differ among PD motor subtypes. TD patients require greater stimulation energy, and PIGD also shows elevated requirements compared with mixed. These findings support subtype-specific programming strategies to balance clinical efficacy and energy efficiency.