Deep Brain Stimulation (DBS) is a surgical therapy that helps manage movement symptoms of Parkinson’s disease when medications become less effective.
The procedure involves implanting electrodes and a neurostimulator device to deliver controlled electrical pulses to brain areas that regulate movement, improving tremor, stiffness and motor fluctuations.
Find out if you are a good candidate for DBS.
While DBS can reduce medication use and enhance quality of life, it carries surgical risks and does not cure or slow Parkinson’s progression.
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 and focused ultrasound, 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.
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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.
Movement symptoms such as tremor, stiffnessand slowness, 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 (extra, involuntary movements), either directly or by allowing lower medication doses.
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, 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 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.
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
The system is turned on, typically a few weeks after implantation surgery.
It sends electrical signals to help regulate brain activity linked to symptoms.
The programming team makes initial adjustments with a specialized device and continues to fine tune the settings as needed.
Adjustments may be guided by recordings of brain activity or scans.
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 places a thin lead into the brain areas the care team has identified to improve symptoms. The small neurostimulator is usually placed under the collarbone, either during the same procedure or a few weeks later.
Depending on the DBS center, the neurosurgeon may perform the surgery while the person is awake or asleep.
Before surgery, several visits are needed for a baseline evaluation, memory and thinking tests and to review the support network. Detailed brain imaging like an MRI or CT scan helps the team plan the procedure.
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.
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.
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
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 (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
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.
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.
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.
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.
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 Dr. Chauncey Spears, Clinical Assistant Professor and Dr. Amelia Heston, Movement Disorders Fellow at the University of Michigan.
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