Deep Brain Stimulation (DBS) involves a surgical procedure in which electrodes are implanted into specific parts of the brain and connected to an implantable pulse generator (IPG), a pacemaker-like device, in the chest area. The IPG sends an electrical signal to the brain to help control motor symptoms associated with Parkinson’s disease, such as slowness, stiffness, and tremor. The IPG’s settings are determined and set by a clinician specializing in DBS programming.
DBS surgery was approved by the FDA for treatment of essential tremor in 1997, and for Parkinson’s disease in 2002. The University of Minnesota’s DBS program has treated nearly 1,000 patients since 1997 and is actively involved in DBS research.
The University of Minnesota has been named a Udall Center of Excellence in Parkinson’s Disease Research since 2016 by the National Institutes of Health. Our multidisciplinary team of physicians, researchers, and engineers work together in both research and clinical settings to better understand and improve DBS therapies for treatment of Parkinson’s disease.
The questions and answers below are based on audience questions at the DBS Question & Answer panel at University of Minnesota’s 2024 Autumn Parkinson’s symposium, but have been edited and adapted for print.
When should I discuss DBS with my doctor? DBS therapy is a decision that should be made together with you, your loved ones, and your doctor. While Parkinson’s disease symptoms vary for each individual, the ideal time to consider DBS is when your motor symptoms are still responding well to levodopa medications, but you aren’t getting the full benefit you desire from medications alone.
Who qualifies for DBS? If you are interested in DBS therapy, and your clinician thinks you may qualify, a standard series of evaluations is done to confirm that DBS would be a safe and effective treatment for you. This includes a consultation with your neurologist, motor testing while on and off your regular Parkinson’s medications, neuropsychological testing, a meeting with a neurosurgeon, and an MRI.
DBS surgery is typically approved for those who have had Parkinson’s disease for at least four years, don’t have severe cognitive issues or dementia, and who respond well to levodopa medications but still experience some complications (such as off periods between medication doses and/or side-effects of levodopa medications).
Is there an increased risk of stroke associated with DBS surgery? DBS surgery is generally considered to be very low risk for stroke (about 1%). As with any brain surgery, there are going to be certain risks, which your neurologist and neurosurgeon will discuss with you.
For someone who has done DBS on one side of their brain, when should that person consider having a DBS lead placed on the other side? After one-sided (“unilateral”) DBS surgery, patients who wish to have signs/symptoms like tremor, stiffness/slowness alleviated on their untreated side may consider a second surgery. Sometimes there are involuntary wriggling movements (i.e., dyskinesias) that are present, and having leads placed on both sides of the brain makes management of this feature easier. It is important to weigh the risks and benefits of having surgery done on the other side. Thus re-evaluation of signs and symptoms of PD are done off and on medications to help clarify the severity of the motor features of PD to help you and the surgical team come to a decision about whether it may be worth a second surgery. DBS does not stop the progression of Parkinson’s disease, so it is true that whether you get DBS surgery or not, your tremor will generally continue to get worse over time.
Can DBS be used to treat dyskinesias? Dyskinesias, which are involuntary movements such as fidgeting, wriggling, and swaying, are often caused by long-term use of levodopa. DBS can effectively treat motor symptoms and usually reduces the need for medication, which can help to reduce those involuntary movements.
If you have more questions about DBS, please ask a movement disorders specialist. If you’re looking for a movement disorders specialist in the Twin Cities area, please see our Clinical Resources page for more info.
Parkinson's Foundation. (n.d.). Deep brain stimulation. Parkinson's Foundation. https://www.parkinson.org/library/fact-sheets/deep-brain-stimulation
M Health Fairview. (n.d.). Deep brain stimulation (adult). M Health Fairview. https://www.mhealthfairview.org/treatments/Deep-Brain-Stimulation-Adult
Michael J. Fox Foundation. (n.d.). Deep brain stimulation. Michael J. Fox Foundation. https://www.michaeljfox.org/deep-brain-stimulation
Medtronic. (n.d.). Right time for DBS therapy. Medtronic. https://www.medtronic.com/en-us/l/patients/treatments-therapies/deep-brain-stimulation-parkinsons-disease/about-dbs-therapy/right-time-for-dbs.html#:~:text=DBS%20Therapy%20is%20a%20personal,well%20as%20they%20used%20to