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However, most studies validating STN beta oscillations as a biomarker used perioperative,\n                      <jats:italic>off<\/jats:italic>\n                      medication, and OFF stimulation conditions, limiting their potential relevance to real\u2010world aDBS deployment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We evaluated how stimulation and dopaminergic medication affect beta\u2010range STN oscillatory activity and its ability to predict the hypokinetic parkinsonian state.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In six patients with Parkinson's disease who experienced residual levodopa\u2010related motor fluctuations despite standard\u2010of\u2010care DBS, we studied medication cycle\u2010induced fluctuations of peak STN beta oscillation power during active DBS. We evaluated the magnitude of beta oscillation fluctuations, the frequency of peak beta activity, and the ability to predict the\n                      <jats:italic>off<\/jats:italic>\n                      medication state. Neural signals were collected in the clinic during a medication challenge and at home during naturalistic medication cycles.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Medication\u2010induced beta oscillation fluctuations were smaller in the presence of therapeutic DBS compared with when the stimulator was off (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.008). Therapeutic stimulation also decreased the frequency of peak beta activity (\n                      <jats:italic>P\u2009&lt;<\/jats:italic>\n                      \u20090.001). As a result, the beta frequencies with the highest power in the OFF stimulation\/\n                      <jats:italic>off<\/jats:italic>\n                      medication state were less accurate than other beta\u2010range bands at predicting the patient's\n                      <jats:italic>off<\/jats:italic>\n                      medication state during active stimulation (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.02).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The spectral characteristics of STN beta oscillations and their performance as a biomarker in aDBS for Parkinson's disease are influenced by the stimulation and medication conditions in which it is implemented. \u00a9 2026 International Parkinson and Movement Disorder Society.<\/jats:p>\n                  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