Parkinson's Disease Treatment with Deep Brain Stimulation
Deep Brain Stimulation for Parkinson’s Disease: What You Need to Know
Deep Brain Stimulation (DBS) is a surgical treatment for Parkinson’s disease (PD) that has been used for over a decade to help manage motor symptoms such as tremor, stiffness, and slowness. While DBS does not cure Parkinson’s or stop it from progressing, it can significantly improve quality of life—especially when medications are no longer providing consistent relief.
When Is DBS Considered?
DBS may be an option if you:
- Have had Parkinson’s disease for at least 4–5 years
- Still respond to medications like carbidopa/levodopa but experience “on-off” fluctuations
- Struggle with dyskinesia (involuntary movements caused by long-term medication use)
- Have symptoms that interfere with your daily life despite optimized medical treatment
DBS is not recommended for individuals with dementia or significant cognitive decline, as it may worsen memory and thinking problems.
What Symptoms Can DBS Help?
DBS is most effective for improving:
- Tremor
- Muscle stiffness (rigidity)
- Slowness of movement (bradykinesia)
It is generally less effective for:
- Balance problems
- Freezing of gait (FOG)
- Non-motor symptoms such as mood changes, sleep disturbances, or fatigue
How Does DBS Work?
DBS involves implanting a small, battery-powered device (neurostimulator) that sends electrical impulses to targeted areas in the brain to help regulate abnormal activity. The system has three main components:
The Lead (Electrode): A thin wire implanted in a specific area of the brain—typically the subthalamic nucleus (STN), globus pallidus interna (GPi), or thalamus.
The Extension: A wire that connects the electrode to the neurostimulator, running under the skin of the head, neck, and shoulder.
The Neurostimulator (Battery Pack): Usually placed under the skin near the collarbone, it delivers continuous electrical stimulation to help control motor symptoms.
What to Expect During Surgery
DBS surgery is often done while the patient is awake but lightly sedated. This allows the team to test electrode placement in real-time by observing your responses to stimulation. A few weeks after surgery, a movement disorder specialist will program your neurostimulator using a handheld device. These settings are gradually adjusted over time to achieve the best symptom control with the fewest side effects. Most people are able to reduce their medication doses after DBS, which may also reduce medication-related side effects like dyskinesia.
Choosing a Brain Target: STN vs. GPi
There are three FDA-approved brain targets for DBS in Parkinson’s disease. The two most commonly used are:
Subthalamic Nucleus (STN):
- Often results in greater medication reduction
- May carry a slightly higher risk for language or cognitive side effects
Globus Pallidus Interna (GPi):
- May be better for people with cognitive or speech concerns
- Typically allows for more modest medication reduction
Target choice is personalized and should be made in collaboration with your neurologist and neurosurgical team.
The Role of Physical Therapy After DBS
While DBS can dramatically improve motor symptoms, its effects on balance, posture, and walking—especially freezing of gait—are less predictable. That’s where physical therapy (PT) comes in.
PT has been shown to improve:
- Balance and posture
- Walking performance
- Symptoms not responsive to medication, such as freezing and festination
Experts agree that PT should be part of the care plan after DBS. Conventional physical therapy—not massage or manual therapy—has shown the most benefit and should be prescribed as part of a comprehensive, multidisciplinary approach. LSVT Big and Loud are rehabilitative treatment programs that are designed specifically for people with Parkinson's Disease and have been especially effective in training people with Parkinson disease to use their body more normally.
Am I a Good Candidate for DBS?
You might be a good candidate if:
- You’ve had Parkinson’s for 5 or more years
- You respond to medications but experience "on-off" fluctuations
- You’ve tried various medications without consistent benefit
- Your symptoms are interfering with daily life, work, or safety
What Are the Risks?
As with any surgical procedure, DBS carries some risks, including:
- Infection (1–3%)
- Bleeding or stroke
- Hardware complications
- Side effects from anesthesia
Your medical team will review your overall health and individual risk factors before recommending surgery.
What Is the Outlook After DBS?
DBS does not cure Parkinson’s, but it can bring years of meaningful symptom relief. Most people experience:
- Fewer motor fluctuations
- Reduced dyskinesia
- Lower medication doses
- Improved quality of life
The extent of improvement varies, and ongoing adjustment of settings and medications is typically required.
Final Thoughts
Deep Brain Stimulation teamed with physical therapy offers hope and real relief for many people with Parkinson’s disease whose symptoms are no longer well-controlled with medications alone. If you or a loved one is considering DBS, talk to a movement disorder specialist to find out if it’s the right step.