Adaptive deep brain stimulation (aDBS) in Parkinson's disease adjusts stimulation amplitude in real time based on 13–30 Hz subthalamic beta activity and associated physiomarkers. This approach raises new questions about who, why and how to treat patients. The article outlines the pathophysiological rationale for aDBS as an advanced form of therapy. It compares aDBS with conventional DBS in terms of improved motor performance, reduced side effects, and higher energy efficiency. It includes technical developments such as sensing-enabled devices and stimulation algorithms. aDBS dynamically responds to the patient's current needs, unlike the constant stimulation in traditional DBS.[2][3] Potential clinical indications focus on patients with advanced Parkinson's disease.[1]