DBS is a surgery that helps improve some of the motor symptoms of Parkinson’s.

DBS is a surgical procedure that can help some people with Parkinson’s improve some of the bothersome motor symptoms for a period of time… it is not a cure and does not treat non-motor symptoms.

What is DBS?

DBS is a surgical procedure used to treat the often debilitating motor symptoms of Parkinson’s. These include tremor, stiffness, slowed movement, and slowed walking as well as dyskinesia (1). It is important to note that DBS does not cure Parkinson’s, help non-motor symptoms, or stop its progression. DBS’s efficacy, or the magnitude of symptom improvements you experience, will reduce over time. 

Currently DBS is for people whose motor symptoms cannot be adequately controlled with medications any longer but had responded well to levodopa earlier. The procedure will never get you back to 100% but will get you to your best ‘on-state’ while on medication at the time of the procedure.

Tiny electrodes are surgically implanted into the brain and connected by a wire that is run under the skin from your head, down your neck, to connect to a battery (visible around your collarbone area). The pulse generator and electrodes painlessly stimulate the brain in a way that helps to improve many of the symptoms. Initially a decrease in c/l may be achieved, however as the condition progresses, medications may need to be added back into the treatment program.

Who is best suited to DBS?

DBS is not right for everyone, as many symptoms, such as those impacting speech, swallowing, thinking, or gait (balance and freezing), do not consistently respond well to DBS.

DBS is typically recommended for people with advanced Parkinson’s who experience:

  • Motor fluctuations and difficulty in maintaining consistent symptom control with medication.
  • Medication-induced dyskinesia, or involuntary movements caused by long-term use of Parkinson’s medications.
  • Severe tremors that are not adequately controlled by medication.

Pros:

  • While there may be some scarring, DBS does not damage healthy brain tissue or destroy nerve cells.
  • The procedure interrupts problematic electrical signals from targeted areas in the brain.
  • The settings can be adjusted as symptoms change.
  • Some people may be able to reduce their medication at first.
  • Research cites the 3-year DBS Honeymoon provides the most relief from symptoms, with tremor and stiffness relief often lasting over 10 years.

Cons:

  • As with any surgery, there are risks such as infection, bleeding, stroke, or seizures.
  • DBS does not stop Parkinson’s from progressing or remove the need for medicines completely.
  • Some people may experience side effects after the DBS Honeymoon such as speech changes, balance problems, or mood changes.
  • Symptoms like freezing of gait, balance issues, swallowing problems, and thinking changes often do not improve with DBS.

Adaptive DBS

Adaptive DBS (aDBS), was approved for use in 2025. It is a newer programming approach that uses information from detected brain signals to automatically adjust stimulation. It may be suitable for some people with Parkinson’s following assessment by their treating team. Standard DBS and adaptive DBS are different approaches to delivering stimulation, and the most appropriate option will depend on the individual patient and their clinical circumstances.

DBS can be life-changing for many people with Parkinson’s, but it’s important to have realistic expectations about which symptoms will get treated and which will not. It is important to discuss all potential risks and benefits with your care team.

Key Statistics

  • DBS is a surgery shown to increase the quality of life in patients with advanced Parkinson’s that results in large motor fluctuations, severe tremor and dyskinesias not controlled by medications. (1)
  • The most common side-effect of DBS is dysarthria (speech changes) regardless of electrode placement. (2)
  • DBS for Parkinson’s remains an efficient symptomatic treatment, although the amount of improvement tends to decline over time. (2)

In Australia, access to Deep Brain Stimulation (DBS) or the newer Adaptive DBS (aDBS) follows a specific, multi-step clinical pathway. This process makes sure that surgery is only performed on patients who are likely to see a significant improvement in their quality of life.

1. Initial consultation & discussion

The journey usually begins with a discussion between you and your neurologist. They will evaluate whether your symptoms, such as tremors or “off” times, are no longer well-controlled by oral tablets.

2. Referrals

If your neurologist believes you are a suitable candidate, they will refer you to a hospital that does DBS. In Australia, these centres have established teams that include neurosurgeons, movement disorder neurologists, and specialised nurses who work together to manage your care.

3. Testing process (Evaluation)

Before surgery is approved, you must undergo a series of detailed tests with a multi-disciplinary team. This team usually includes a psychiatrist and a neuropsychologist to ensure you do not have severe memory or mood problems that surgery could worsen.

A critical part of this is the Levodopa Challenge Test. You will be asked to stop your medication overnight and then take a dose in the clinic to see if your symptoms improve by at least 30-33%. If the medication still helps your movement, DBS is more likely to be successful.

4. Surgical planning & imaging

Once you are cleared for surgery, a high-resolution MRI or CT scan is performed. This allows the surgeon to see your brain’s unique anatomy and plan a safe path for the wires, ensuring they avoid blood vessels and target the correct area (e.g. the STN or GPi).

5. The surgical procedure

The operation is typically completed in two main stages:

  • Step 1: Lead placement. Very thin wires (electrodes) are placed into specific areas of the brain. This can be done while you are awake so the team can test the effect on your symptoms immediately, or under general anaesthesia using advanced imaging to guide the placement.
  • Step 2: Implanting the pulse generator. A few weeks later (or sometimes during the same session), a small battery-operated device called a neuro-stimulator is placed under the skin near your collarbone. Wires are then tunnelled under the skin of your neck to connect the brain electrodes to this battery.

6. Activation & initial programming

You do not feel the benefits immediately, as the device is usually kept off for a few weeks to allow your brain to heal. During a follow-up visit, your neurologist will turn the system on and find the “therapeutic window,” or the range where your symptoms improve without causing side effects like tingling or speech changes.

7. Long-term care & adjustments

DBS is a lifelong commitment. You will have regular follow-up appointments to fine-tune your settings and adjust your medications. You will also learn to use a handheld controller or phone app to check your battery life and turn the device on or off if needed. Non-rechargeable batteries typically need to be replaced every 5 to 9 years.

It does come with specific limitations and lifestyle considerations based on the hardware and the nature of the therapy. Having an advanced therapy like DBS can sometimes result in exclusion from other clinical trials.

A Decision Aid For Deep Brain Stimulation (DBS) Surgery

Michelle Fullard, MD, MSCE, and her team at UC Health Anschutz Medical Campus in Colorado have developed an interactive, online decision aid to help guide patients through the Deep Brain Stimulation (DBS) process. This resource walks patients through multiple aspects of the DBS journey, including:

1. Weighing the Potential Risks and Benefits: Understanding the potential advantages and drawbacks of DBS.
2. Understanding the Surgery: Detailed information on how the surgery is performed.
3. Recovery Process: What to expect during the recovery period.

This online decision aid is designed to provide patients with comprehensive information to make informed decisions about DBS, ensuring they are well-prepared for each stage of the process. (© 2024 University of Colorado Denver – Anschutz | Department of Neurology)

n.b. Parkinson’s Australia does not take responsibility for any third-party information and this is used to guide you in consultation with your neurologist.

Infosheet under review

For help with your device, contact your device manufacturer:

  • Abbott Customer Service (DBS devices): Open 24 hours 1800 839 259
  • Medtronic Customer Service (DBS devices): Open 24 hours 1800 668 670
  • Boston Scientific (DBS devices): Open 24 hours 1800 245 559

References

(1) Rajamani, N., Friedrich, H., Butenko, K. et al. Deep brain stimulation of symptom-specific networks in Parkinson’s disease. Nat Commun 15, 4662 (2024). https://doi.org/10.1038/s41467-024-48731-1

(2) Hariz, M., & Blomstedt, P. (2022). Deep brain stimulation for Parkinson’s disease. Journal of internal medicine, 292(5), 764–778. https://doi.org/10.1111/joim.13541

  • Mahlknecht P, Foltynie T, Limousin P, Poewe W. How Does Deep Brain Stimulation Change the Course of Parkinson’s Disease? Mov Disord 2022;37:1581–92.
  • Deuschl G, Schade-Brittinger C, Krack P, Volkmann J, Schäfer H, Bötzel K, et al. A Randomized Trial of Deep-Brain Stimulation for Parkinson’s Disease. N Engl J Med 2006;355:896–908.
  • Williams A, Gill S, Varma T, Jenkinson C, Quinn N, Mitchell R, et al. Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson’s disease (PD SURG trial): a randomised, open-label trial. Lancet Neurol 2010;9:581–91.
  • Okun MS, Gallo B V., Mandybur G, Jagid J, Foote KD, Revilla FJ, et al. Subthalamic deep brain stimulation with a constant-current device in Parkinson’s disease: an open- label randomised controlled trial. Lancet Neurol 2012;11:140–9.
  • Weaver FM, Follett K, Stern M, Hur K, Harris C, Marks WJ, et al. Bilateral deep brain stimulation vs best medical therapy for patients with advanced parkinson disease: A randomized controlled trial. JAMA – J Am Med Assoc 2009;301:63–73.
  • Vitek JL, Jain R, Chen L, Tröster AI, Schrock LE, House PA, et al. Subthalamic nucleus deep brain stimulation with a multiple independent constant current-controlled device in Parkinson’s disease (INTREPID): a multicentre, double-blind, randomised, sham- controlled study. Lancet Neurol 2020;19:491–501.
  • Schuepbach WMM, Rau J, Knudsen K, Volkmann J, Krack P, Timmermann L, et al. Neurostimulation for Parkinson’s disease with early motor complications. N Engl J Med 2013;368:610–22.
  • Daniels C, Krack P, Volkmann J, Raethjen J, Pinsker MO, Kloss M, et al. Is improvement in the quality of life after subthalamic nucleus stimulation in Parkinson’s disease predictable? Mov Disord 2011;26:2516–21.
  • Lachenmayer ML, Mürset M, Antih N, Debove I, Muellner J, Bompart M, et al. Subthalamic and pallidal deep brain stimulation for Parkinson’s disease-meta-analysis of outcomes. NPJ Park Dis 2021;7: 77.
  • Perestelo-Pérez L, Rivero-Santana A, Pérez-Ramos J, Serrano-Pérez P, Panetta J, Hilarion P. Deep brain stimulation in Parkinson’s disease: meta-analysis of randomized controlled trials. J Neurol 2014;261:2051–60.
  • Mansouri A, Taslimi S, Badhiwala JH, Witiw CD, Nassiri F, Odekerken VJJ, et al. Deep brain stimulation for Parkinson’s disease: meta-analysis of results of randomized trials at varying lengths of follow-up. J Neurosurg 2018;128:1199–213.

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