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In the therapy of Parkinson̓s disease, both the intrajejunal administration of Levodopa/Carbidopa Intestinal Gel (LCIG) and, more recently, Levodopa/Carbidopa/Entacapone Intestinal Gel (LECIG), as well as deep brain stimulation (DBS), are employed. These approaches differ significantly in their efficacy and side effect profiles, as well as the timing of their use. Yet, the initiation of therapy for both methods is often simultaneously considered when patients have reached an advanced stage of the disease. From the authors' perspective, however, patients may reach the milestones for the indication of one of these respective treatments at different points in the course of the disease. Individual disease progression plays a pivotal role in this regard. The concept that all patients become candidates for a specific treatment at a predefined time appears erroneous to the authors. In the context of this review, therefore, the therapeutic modalities are presented in terms of their efficacy for different symptoms, the notion of simultaneous timing of their initiation is questioned, and an individualized therapy evaluation is derived, with a focus on quality of life and participation., Competing Interests: N Schröter ist als Referent und/oder Berater für AbbVie und Stada tätig. WH Jost ist als Referent und/oder Berater für Abbvie und Britannia/Stada tätig. M Rijntjes ist als Referent und/oder Berater für AbbVie und Stada tätig. VA Coenen ist Berater für Ceregate; Aleva; CorTec und Inbrain. Er bekommt Unterstützung für einen IIT im Bereich THS von BostonScientific. Er erhält ein dauerhaftes Grant von BrainLab zur Finanzierung einer Post-Doc-Stelle. S Groppa erhielt Forschungsförderung von Patientenorganisationen, BMBF, DFG, UM Mainz, Abbott, Boston Scientific, Böhringer Foundation, Magventure, Precisis, Innovationsfond GBA und ist als Referent tätig für Abbott, Abbvie, Bial, BVDN, IPSEN, Stada, UCB. B Sajonz hat eine Forschungsförderung von Ceregate erhalten., (Thieme. All rights reserved.)

Background: Deep brain stimulation (DBS) is a highly efficient, evidence-based therapy to alleviate symptoms and improve quality of life in movement disorders such as Parkinson's disease, essential tremor, and dystonia, which is also being applied in several psychiatric disorders, such as obsessive-compulsive disorder and depression, when they are otherwise resistant to therapy., Summary: At present, DBS is clinically applied in the so-called open-loop approach, with fixed stimulation parameters, irrespective of the patients' clinical state(s). This approach ignores the brain states or feedback from the central nervous system or peripheral recordings, thus potentially limiting its efficacy and inducing side effects by stimulation of the targeted networks below or above the therapeutic level., Key Messages: The currently emerging closed-loop (CL) approaches are designed to adapt stimulation parameters to the electrophysiological surrogates of disease symptoms and states. CL-DBS paves the way for adaptive personalized DBS protocols. This review elaborates on the perspectives of the CL technology and discusses its opportunities as well as its potential pitfalls for both clinical and research use in neuropsychiatric disorders., (© 2023 The Author(s). Published by S. Karger AG, Basel.)