## Breadcrumb - [Home](/) - [Living with Parkinson's](/living-with-parkinsons) - [Treatment](/living-with-parkinsons/treatment) - [Surgical Treatment Options](/living-with-parkinsons/treatment/surgical-treatment-options) ## Breadcrumb - [Home](/) - [Living with Parkinson's](/living-with-parkinsons) - [Treatment](/living-with-parkinsons/treatment) - [Surgical Treatment Options](/living-with-parkinsons/treatment/surgical-treatment-options) # Deep Brain Stimulation (DBS) ## 💡 Quick Summary - Deep Brain Stimulation (DBS) is surgery that helps control Parkinson’s [movement symptoms](/understanding-parkinsons/movement-symptoms "Movement Symptoms") when medications alone are not enough. - The procedure involves implanting a system that sends electrical pulses to areas of the brain controlling movement. - DBS improves quality of life for some people and can reduce [tremor](/understanding-parkinsons/movement-symptoms/tremor "Tremor"), [stiffness](/understanding-parkinsons/movement-symptoms/rigidity "Rigidity"), slowness, [dyskinesia](/understanding-parkinsons/movement-symptoms/dyskinesia "Dyskinesia") (involuntary movements) and fluctuations in movement control between medication doses. - Talk to your PD doctor to see if DBS is an option for you. ![Doctors performing surgery](/sites/default/files/styles/no_sizing/public/images/dbs.jpg?itok=ONDkLtNq) Deep brain stimulation (DBS) is an advanced treatment used to manage Parkinson’s disease (PD). During DBS surgery, a small opening is made in the skull to place thin wires in specific areas of the brain. These wires are connected to a small device implanted under the skin near the collarbone. The device sends electrical signals through the wires that can help reduce movement symptoms such as tremor, stiffness and slowness, and may also improve certain medication-related challenges. Like other advanced Parkinson’s treatments, including **[pump medications](https://www.parkinson.org/living-with-parkinsons/treatment/prescription-medications)** and **[focused ultrasound](https://www.parkinson.org/living-with-parkinsons/treatment/surgical-options/other-surgical-options)**, DBS may be considered when oral medications no longer control symptoms or cause difficult side effects. Because DBS involves brain surgery, the decision requires careful evaluation and planning with your care team. ### Download your free Advanced Treatment Options guide Learn more about advanced treatments, including why they are used and the benefits, risks and possible side effects to consider. [Download now](/library/books/advanced-treatment-options) The U.S. Food and Drug Administration (FDA) has approved DBS for Parkinson’s disease and related features at these milestones: - **1997** — to treat Parkinson’s tremor - **2002** — to treat advanced Parkinson’s symptoms - **2016** — for earlier stages of Parkinson’s (diagnosed for at least four years and movement symptoms not adequately controlled with medication) - **2025** — to add an optional programming feature called adaptive deep brain stimulation (aDBS) for certain DBS systems ### How DBS Works Parkinson’s affects a part of the brain called the substantia nigra. This area has more than 400,000 cells that produce dopamine, a chemical that helps control movement, mood and other functions. The substantia nigra connects to other areas of the brain, including the globus pallidus internus (GPi) and the subthalamic nucleus (STN). These regions control movement in the arms, legs and neck, and influence mood, thinking and more. As PD progresses, cells that produce dopamine become damaged and die over time. Dopamine levels gradually decrease, and brain regions involved in movement stop working together smoothly. This leads to abnormal brain activity, which can cause tremor, stiffness and slow movement. DBS sends electrical pulses through thin wires to help reset abnormal brain signals and improve movement. The exact reason DBS works is not fully understood, however, it has been shown to reduce movement symptoms. ## What symptoms does DBS help manage? DBS is most effective for improving movement symptoms and reducing fluctuations (the ups and downs in symptoms as medication wears off or takes effect). It may also help with some non-movement symptoms. In general, symptoms that respond at least partially to levodopa, the primary medication for Parkinson’s movement symptoms, often improve with DBS. After surgery, many people take less medication than before to surgery, which can help reduce side effects. - ### DBS may help with: - Movement symptoms such as **[tremor](https://www.parkinson.org/understanding-parkinsons/movement-symptoms/tremor)**, **[stiffness](https://www.parkinson.org/understanding-parkinsons/movement-symptoms/rigidity) and **[slowness](https://www.parkinson.org/understanding-parkinsons/movement-symptoms/bradykinesia)**, especially if they respond to levodopa. - Tremor can improve with DBS even if it doesn’t improve with levodopa. - Medication side effects, such as **[dyskinesia](https://www.parkinson.org/understanding-parkinsons/movement-symptoms/dyskinesia)** (extra, involuntary movements), either directly or by allowing lower medication doses. - Some non-movement symptoms including **[sleep issues](https://www.parkinson.org/understanding-parkinsons/non-movement-symptoms/sleep-disorders)**, **[pain](https://www.parkinson.org/understanding-parkinsons/non-movement-symptoms/pain)** and **[overactive bladder](https://www.parkinson.org/understanding-parkinsons/non-movement-symptoms/incontinence)**. - ### DBS may not help: - Mood, energy and walking, especially if these didn’t improve with levodopa before DBS. - ### DBS may worsen: - **[Balance](https://www.parkinson.org/understanding-parkinsons/movement-symptoms/postural-instability)**, **[speech and swallowing problems](https://www.parkinson.org/understanding-parkinsons/non-movement-symptoms/speech-swallowing)** especially if experienced before DBS. - Typically, these changes are related to stimulation and can improve or go away by adjusting the device settings. **Important to know:** DBS can improve symptoms, but ongoing follow up is essential. Your care team will regularly adjust medication and stimulation settings as symptoms change over time. ### Brain Areas for DBS DBS helps manage Parkinson’s symptoms through delivering electrical stimulation to specific areas of the brain. The FDA has approved three target areas for DBS called the: - Globus pallidus internus (GPi) - Subthalamic nucleus (STN) - Ventral intermediate nucleus (VIM) Each target area has different benefits. The area of stimulation is based on a person’s symptoms and treatment goals. ## About the DBS System The DBS system consists of three components: - ### The Neurostimulator The neurostimulator, also called implantable pulse generator (IPG), is the control center of the DBS system. It sends signals to the brain based on individualized programmed settings. The neurostimulator: - Is placed under the skin, usually near the collarbone - Stores the settings that control how stimulation is delivered - Sends signals through leads - Comes with rechargeable or non-rechargeable batteries - ### Leads Leads are thin wires implanted in the brain that carry electrical signals from the neurostimulator to the brain. If symptoms affect both sides of the body, two leads — one on each side of the brain — are typically used. Each lead: - Has 4 to 16 electrodes (metal contacts) that direct electrical pulses to targeted areas. - Uses directional stimulation, which means signals can be aimed at specific brain areas while avoiding others. This helps treat symptoms and avoid unwanted side effects. - Connects to an extension wire that runs under the skin to the neurostimulator. - ### Controller The DBS system also includes a controller that can be a handheld device or an app on a phone or tablet. With the controller, the person with DBS can: - Turn the neurostimulator on or off - Check battery status - Make limited adjustments as programmed by the DBS team - Participate in remote programming sessions, depending on the system - ### How the System Works 1. The system is turned on, typically a few weeks after implantation surgery. 2. It sends electrical signals to help regulate brain activity linked to symptoms. 3. The programming team makes initial adjustments with a specialized device and continues to fine tune the settings as needed. 4. Adjustments may be guided by recordings of brain activity or scans. - ### Unique Device Features Some DBS systems offer extra features, each with possible benefits and considerations. - **Adaptive DBS:** Unlike standard DBS systems with fixed settings, adaptive DBS (aDBS) also adjusts stimulation in response to brain activity. - **Potential benefit:** It may help personalize stimulation based on real-time data. - **Consideration:** Some people may not have brain signals that are strong or consistent enough to guide this feature. - **Image-guided programming:** Uses brain scans to show lead placement and stimulation areas. - **Potential benefit:** Image-guided programming may make stimulation adjustments faster and easier - **Consideration:** It requires specialized imaging tools and coordination between surgical and programming teams. - **Remote programming:** Allows the programming team to adjust settings from a distance by connecting to the controller or app during a scheduled session. - **Potential benefit:** Remote programming may allow quicker access to stimulation adjustments and reduce the need to travel. - **Consideration:** It relies on strong internet connection and may not be offered at all clinics. Abbott, Boston Scientific and Medtronic make FDA-approved DBS systems for treating Parkinson’s symptoms. Each system has unique features and components. ## DBS Surgery DBS surgery typically involves two surgeries: one to place the leads in the brain and another to implant the neurostimulator under the collarbone. Anesthesia (medication that blocks pain) is used to manage discomfort and pain during the surgery. Depending on the approach, the surgeon may use local anesthesia that numbs the surgery site, or general anesthesia, which keeps the person asleep throughout the procedure. - ### Before Surgery Preparing for surgery usually requires several visits. These visits usually include: - **Evaluation of symptoms, memory and thinking** to establish a clear baseline. - **Review of the support network** to help plan for post-surgery care. - **Brain imaging (MRI or CT scan)** to guide the surgery. - ### During Surgery - **Lead placement** — The leads are positioned in the targeted brain areas through small openings in the skull. Surgery may be done while awake or asleep, depending on the center. - **Neurostimulator placement** — The device is usually placed under the collarbone. In some cases, it may be placed in the abdomen or another location. This may happen during the same surgery as the leads or a few weeks later. - ### After Surgery - **Hospital stay** — Most people stay in the hospital 1–3 days after the leads are placed in the brain. If the neurostimulator is implanted later, it is usually done as a same day procedure, meaning the person goes home the same day. - **Recovery at home** — This includes rest and support from a care partner while the incision sites heal. - **Device activation** — The device is activated and programmed after recovery, typically several weeks later. ## DBS Programming After surgery, the DBS device needs to be adjusted to match each person’s symptoms. This means turning the device on and identifying stimulation settings that reduce symptoms while avoiding side effects. Programming usually starts soon after surgery and takes several visits to find the best settings. It continues over time through follow-up appointments to fine-tune settings as symptoms or treatment goals change. - ### Initial programming - During this visit the DBS team will turn on the device and adjust settings to find the range that improves symptoms while causing few or no side effects. This is called the therapeutic window. - The team will test different combinations of settings within this range to see which works most effectively. - ### Ongoing programming - The number and timing of appointments vary by DBS center. - Some centers schedule check-ins every one to two months during the first six months while others space them out. - After therapy stabilizes, many people only need one to two follow-ups per year. - During these visits, the DBS team will adjust settings based on any changes in symptoms or side effects update. - They also check the device’s battery and update Parkinson’s medications as needed. ## FAQs - ### Am I a good candidate for DBS? First, consult a movement disorders specialist for a thorough evaluation of your symptoms, medications and health history. DBS may be an option if you: - Have a diagnosis of Parkinson’s confirmed by a specialist - Experience some improvement in symptom management with levodopa medication - Have tried medication adjustments but still experience “off” time or side effects that affect daily life - Have symptoms such as tremor or **[dystonia](https://www.parkinson.org/understanding-parkinsons/movement-symptoms/dystonia)** (painful cramping) that don’t get better with medication - Do not have serious mood, mental health or cognitive (thinking) problems - Are healthy enough for surgery - Have a support network who can help during surgery recovery and after - Understand what DBS can and cannot do - ### Can I stop taking medications after DBS? Some people can reduce their PD medication doses after DBS, especially for tremor or dyskinesia (extra, involuntary movements). But most continue taking some medication, as symptoms will continue to change over time. Managing Parkinson’s usually involves a combination of treatments — including medication, exercise and other therapies — tailored to each person’s symptoms and needs. - ### What are the side effects of DBS? Most side effects of DBS are short term and often improve when medications or stimulation settings are adjusted. The most common short-term stimulation side effects usually go away within days or weeks and include: - Sensory effects such as headache, dizziness, tingling or electric shock-like sensations. - Mood, memory and thinking changes. The most common long-term stimulation side effects may last longer or could come and go. They include: - Slurred speech - Trouble with balance - Dyskinesia (extra, involuntary movements) - Muscle pulling or tightness - Trouble walking, including freezing (feeling stuck in place) - Problems with coordination For a full list, discuss side effects with your DBS team. - ### Will I feel electricity from the DBS device? People usually don’t feel anything during daily use. Some people might notice tingling or dizziness when the device is turned on or adjusted, but it usually goes away quickly. - ### What are the risks of surgery? Complications, such as the following, can occur during or in the days following DBS surgery: - Pain, numbness, swelling or inflammation at the surgery sites: These are common but usually temporary. Worsening symptoms may signal infection. - Infections in the brain, scalp or chest area: These mostly affect the tissue around the implanted device in the scalp or chest; brain infections are very rare. - Allergic reactions to implanted materials: Share any known allergies to metals or implants with your DBS team early on. - Confusion: Temporary disorientation may occur after surgery, especially in older adults. This usually improves within a few days. - Seizures: While rare, seizures are possible during or shortly after surgery — usually within 24 hours, sometimes within a week. For a full list of complications and risks, speak with your DBS team. - ### What if DBS does not work? DBS failure can happen, but most causes — such as issues with lead placement, hardware or programming — can often be fixed. DBS can also fail if someone is not a good candidate for surgery. It is important to work with an experienced DBS center and team, since careful evaluation helps decide who should receive DBS. *Page reviewed by: Michael Okun, MD, National Medical Advisor for the Parkinson’s Foundation, and Pamela Zeilman, MSN, ANP-BC, Norman Fixel Institute for Neurological Diseases, University of Florida Health Alfonso Fasano, MD, PhD, Staff Neurologist and Co-director of the Surgical Program for Movement Disorders, Toronto Western Hospital, Chair in Neuromodulation, University of Toronto and Professor of Neurology, Humanitas University, Milan, Italy Arjun Tarakad, MD, Associate Professor of Neurology and Director of Deep Brain Stimulation Program, Baylor College of MedicinePage* ### Looking for inspiration? My PD Story features real stories from people in the Parkinson’s community. Hear from those who have chosen DBS or other advanced treatments. [Click here](/living-with-parkinsons/stories) ## Related Materials Fact Sheets ### [ Considering Deep Brain Stimulation ](/library/fact-sheets/deep-brain-stimulation) [Read Now](/library/fact-sheets/deep-brain-stimulation) Podcasts ### [ Episode 112: Non-pharmaceutical Treatments for PD: DBS and Focused Ultrasound ](/library/podcast/112) [Listen Now](/library/podcast/112) Videos & Webinars ### [ Understanding Deep Brain Stimulation (DBS) ](/library/videos/understanding-dbs) [Watch Now](/library/videos/understanding-dbs) ## Related Blog Posts ![Mel Mitchell headshot](/sites/default/files/styles/500x360/public/images/dbs-questions-blog-preview.jpg?h=9105c3fe&itok=Sj4QsRgx) Raise Awareness ### [ 8 Questions You’ve Always Wanted to Ask About Deep Brain Stimulation Surgery ](/blog/awareness/dbs-questions) READ NOW ![stethoscope](/sites/default/files/styles/500x360/public/images/toledotrial-bloghero.png?h=ed9ce7df&itok=pbjM1za4) Advancing Research ### [ What’s Hot in PD? Choosing Between Subcutaneous Apomorphine Infusions, Intestinal Pumps (Duopa) and Deep Brain Stimulation: Implications of the TOLEDO Trial ](/blog/research/intestinal-pumps) READ NOW ![Doctors looking at a brain scan on an ipad](/sites/default/files/styles/500x360/public/images/RestingTremorDBS-Blog.png?h=5193ff8a&itok=X56vxF1H) Science News ### [ Resting Tremor and DBS. Sooner Better Than Later? ](/blog/science-news/resting-tremor) READ NOW ### Order a Parkinson’s Hospital Safety Guide The Hospital Safety Guide is a resource for people with Parkinson's and their care partners filled with useful tools and information to prepare for and navigate a hospital stay. [ORDER NOW](/resources-support/pd-library/order-publications) [LEARN MORE](/resources-support/hospital-safety-guide) - Share on Facebook - Share on X - Share on LinkedIn