Simplified, Scalable, 24-hour Adaptive DBS in Parkinson's Disease

Inclusion criteria 1. Age 25-75. 2. Diagnosis of idiopathic PD. 3. Patient has undergone appropriate therapy with oral medications with inadequate relief as determined by a movement disorders neurologist (Dr. Bledsoe). 4. Patient has requested surgical intervention with deep brain stimulation for their disorder or previous enrollment in sponsored IDE (G220241) to use Percept PC wired to subgaleal sensing, if patients have ongoing daytime fluctuations or sleep dysfunction despite cDBS optimization. 5. Normal preoperative brain MRI. 6. Absence of significant cognitive impairment (score of 24 or greater on the Montreal Cognitive Assessment (MoCA). 7. Signed informed consent. 8. Motor UPDRS-III off medication score 25 to 65 and a \>35% improvement with levodopa, predominant rigid/bradykinetic symptoms (ratio of off-medication UPDRS-III limb rigidity/bradykinesia scores to limb tremor scores of \>1.2). 9. Motor fluctuations despite optimized medical therapy with at least 2 hours per day of either "off" time, or "on" with dyskinesias. 10. Ability to comply with study follow-up visits for brain recording, testing of closed-loop stimulation, and clinical assessment. Exclusion criteria 1. Coagulopathy, uncontrolled hypertension, heart disease, or other medical condition considered to place the patient at elevated risk for surgical complications. 2. Patient meets criteria for a psychogenic movement disorder. 3. Pregnancy: all women of childbearing potential will have a negative urine pregnancy test prior to undergoing their surgical procedure. 4. Significant untreated depression (BDI-II score \>20) History of suicidal attempt or active suicidal ideation (Yes to #2-5 on C-SSRS). 5. Any personality or mood symptoms that study personnel believe will interfere with study requirements. 6. Patient who requires electroconvulsive therapy, repetitive transcranial magnetic stimulation, or diathermy, implanted neurostimulators and MR-incompatible metallic implants, previous craniotomy on the side of the intended subgaleal implant, and drug or alcohol abuse. 7. Patients who experience adverse effects that are undesirable and detrimental to the health of subjects from DBS or other similar neurostimulators