Conventional deep brain stimulation (cDBS) is an established treatment for Parkinson's disease (PD), whereas adaptive DBS (aDBS) represents a promising approach with potential advantages in minimizing stimulation-induced side effects and enhancing quality of life. This study evaluated the safety and efficacy of a newly developed aDBS closed-loop neurostimulation (CNS) device for one year across multiple centers, with the primary objective of comparing the outcomes of aDBS and cDBS.This retrospective study included 62 patients with PD who underwent bilateral subthalamic nucleus (STN) DBS. Outcomes were assessed using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Parkinson's Disease Questionnaire-39 (PDQ-39), and Schwab and England Activities Scale, whereas the levodopa-equivalent daily dose (LEDD) and adverse events were monitored. This two-phase trial randomized participants into Stim-on or Stim-off groups for 90-day postoperative comparison followed by nonrandomized evaluation of aDBS vs cDBS at 360 days after surgery.At 90 days postoperatively, the Stim-on group exhibited superior outcomes to those in the Stim-off group except for LEDD and speech in the medication-on state. At the 360-day postoperative assessment, the aDBS group showed significantly greater improvements than did the cDBS group in MDS-UPDRS II (57.29% vs 33.02%, p = 0.022), MDS-UPDRS IV (59.83% vs 36.69%, p = 0.026), PDQ-39 (56.91% vs 27.37%, p = 0.031), and LEDD reduction (53.35% vs 29.16%, p = 0.002). CNS aDBS recorded clear STN-beta signals, which could be adopted as a biomarker.Both aDBS and cDBS significantly alleviate motor symptoms and enhance quality of life in patients with PD. Although comparable in motor symptom control, aDBS indicated advantages over cDBS across LEDD reduction, MDS-UPDRS II, MDS-UPDRS IV, and PDQ-39 over the long term. Further studies with extended follow-up and larger sample sizes are required to validate these results.Copyright © 2025 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.