Deep Brain Stimulation (DBS) Surgery

DBS for Parkinson’s disease and movement disorders

A middle-aged man sits with a medical professional during a DBS programming session for treatment for Parkinson's symptoms.

DBS for Parkinson’s disease and movement disorders

The Deep Brain Stimulation Program at Scripps Clinic is part of the Parkinson’s Disease and Movement Disorder Center in La Jolla. Deep brain stimulation (DBS) surgery can be an option when Parkinson’s and related movement disorder symptoms need supplemental surgical treatment. This FDA-approved surgery has helped more than 100,000 patients worldwide who have Parkinson’s disease, essential tremor and dystonia.


Across San Diego County, Scripps doctors specially trained in DBS surgery are helping patients improve their quality of life through this surgical procedure. Our neurologists and neurosurgeons work together to provide the most appropriate treatment, and participate in ongoing research with the goal of advancing the science of DBS and making continued improvements in patient outcomes.

The expertise of Scripps

The Scripps Deep Brain Stimulation Program brings together specialists in DBS surgery, the most advanced technology and the nationally recognized expertise of Scripps.


Our DBS team includes:


Physicians:



Nurse Practitioners/Physician Assistants:



Neuropsychologist:


What is deep brain stimulation surgery?

Deep brain stimulation (DBS) is a therapy most often used to treat symptoms of Parkinson’s disease, including tremor, rigidity, stiffness, slowed movement and walking problems. DBS is also used to treat essential tremor, dystonia, Tourette syndrome and obsessive/compulsive disorder (OCD).

How does DBS surgery work?

DBS involves implanting a device about the size of a stopwatch under the skin of the chest. The device delivers electrical stimulation to the brain through a thin insulated wire that connects to electrodes placed in the skull. DBS stimulates specific areas of the brain to treat and improve debilitating tremors and Parkinson’s symptoms. Essentially, DBS is a “brain pacemaker.”

What is deep brain stimulation treatment for Parkinson’s disease?

Because Parkinson’s disease is considered a chronic and progressive disease, symptoms worsen over time. Parkinson’s symptoms may include:


  • physical tremor of hands, arms, legs, jaw and face
  • slowness of movement
  • stiffness of limbs and trunk
  • unsteady balance and coordination


Left unchecked, the symptoms can impact quality of life in simple daily activities.


While medications can help manage symptoms of Parkinson’s disease, they cannot provide relief indefinitely. After about five years of treating symptoms with medications, many Parkinson’s patients may begin to experience a decline in their condition. This may be due to the progression of the disease, or the medications may still be effective but cause side effects that patients cannot tolerate. 


Most candidates for deep brain stimulation surgery have had Parkinson’s symptoms for several years and may be experiencing changes in their symptoms, including:


  • Shorter periods of relief from symptoms 
  • Needing different combinations of medications
  • Having symptoms that interfere with daily activities
  • “On/off” fluctuation of symptoms with involuntary “wiggly” types of movements (known as dyskinesia) due to the Parkinson’s medications 

What are the benefits of DBS?

Deep brain stimulation (DBS) has helped people remain in their careers, care for their families, resume favorite activities and once again do simple things in daily life. Clinical studies have shown that deep brain stimulation surgery, when added as treatment for Parkinson’s disease, can:


  • Provide possibly up to five additional hours of good movement control daily with medications, when compared to medication therapy alone
  • Improve quality of life and make routine daily activities easier
  • In some cases, may significantly reduce medication use, which can result in fewer side effects related to the medications

Is DBS surgery right for you?

DBS is not an appropriate treatment for everyone with Parkinson’s disease. Our neurology specialists carefully evaluate each patient to determine if DBS may be right for them. 


If you answer “yes” to some of the questions below, it could be time to discuss DBS with a Scripps neurologist and find out if you may be a candidate.


  • Are there times when medication is not working well and you’re experiencing symptoms?
  • Do you have trouble with involuntary wiggly types of movements (dyskinesias)?
  • In a typical day, do you take frequent doses of dopaminergic drugs? Examples include pramipexole (Mirapex), ropinirole (Requip), carbidopa/levodopa (Sinemet, Parcopa, Rytary) and carbidopa/levodopa/entacapone (Stalevo).
  • Despite having been prescribed different drug combinations, do you experience any of the following side effects: sleepiness, nausea, hallucinations, confusion or thinking problems, lightheadedness upon standing or behavioral/personality changes?
  • Do you respond to L-dopa therapy?
  • Were you diagnosed with Parkinson’s disease more than four years ago?

About the DBS procedure

Deep brain stimulation therapy uses a small, pacemaker-like device to send electrical signals to an area in the brain that helps fine-tune and control movement. The electrical brain stimulation may, in some cases, block some of the brain messages that cause involuntary and disabling motor symptoms. The device is implanted under the skin in the chest. Small, thin wires connect the device to electrodes placed in your skull, allowing the signals to reach the areas of your brain that are causing your symptoms.


After the DBS system is implanted, your expert DBS programmer adjusts the settings to personalize your DBS therapy. You may need several programming sessions to find your optimal settings. The settings can be adjusted in the future if your symptoms change. Most people do not feel the stimulation, though some may sense a brief tingling when the stimulation is first activated. 


A few weeks after the procedure, most patients can resume normal daily activities. Your DBS clinician will let you know when you can try activities that had been difficult for you prior to deep brain stimulation surgery.


The surgery time can vary in length but typically takes several hours. Patients usually stop taking their medication the evening before the procedure. They arrive at the hospital in the morning, undergo the procedure, and then stay in the hospital after the surgery is complete. Typically, if everything goes well, they will be able to go home the following day. Afterwards, patients may experience slight discomfort and soreness, which can be managed with pain medication.

What to expect during DBS surgery

Implanting the leads

In the first part of the procedure, your neurosurgeon places thin wires called leads into a precise part of your brain. Your brain is “mapped” with an MRI or CT scan to determine the exact location where these leads need to be implanted. 


You will be awake through some parts of the surgery so that you can help your surgeon determine the best place for the leads, but you will not feel any pain. During other parts of the surgery, you will be sedated and even asleep for your comfort. 


Your surgeon may stimulate areas of your brain while you move your arms or legs, tap your fingers, move your hands or pretend to drink from a cup. This helps your surgeon find the best lead position to control symptoms like tremor, rigidity or slowness of movement to have the most benefit with the least amount of side effects from brain stimulation.


Implanting the leads requires an overnight stay at the hospital. Most people are able to return home the day after surgery.


Implanting the neurostimulator

The neurostimulator is the device that sends the electrical impulses to the leads that have been inserted into the brain. The device is implanted two weeks after the DBS leads are placed. You will be sedated and asleep for this part of the procedure. 


The neurostimulator is implanted under the skin of your chest, just below the collarbone. The surgeon will also connect the leads to the neurostimulator with extensions. Extensions are insulated wires that are placed under the skin and run up from the chest to your neck and head. 


This requires an outpatient visit, and the placement may take up to four hours. You will return home the same day.

DBS surgery recovery and healing

Patients are usually able to return home the day after DBS surgery. Healing can take several weeks, and we will give you medication to manage any pain. Typically, we will not activate your device until your first programming session. 


For the first several weeks after your device is implanted, we generally recommend avoiding strenuous activity and arm movements above the shoulder. You doctor will let you know when you can try to do more strenuous activities that were difficult before your surgery.

DBS programming sessions

After you have healed from surgery — typically a few weeks after the procedure — your health care provider will program the device to best control your symptoms while minimizing side effects. Follow-up sessions are opportunities to further adjust settings to optimize your treatment. Periodic adjustments are also a normal part of DBS therapy. 


After the initial programming, people with tremor may feel a brief tingling sensation, and usually experience relief from symptoms almost immediately. But results may vary, as some people may need months of programming before they experience the maximum benefit of DBS therapy. 


You may have a controller that allows you to adjust the settings at home, turn it off and on and monitor the battery life.

Risks of DBS surgery

Brain stimulation therapy requires brain surgery. Risks of brain surgery may include serious complications, such as infection, bleeding inside the brain, strokes, seizures and coma. Some of these may be fatal. Fortunately, many of these serious risks are very rare and, overall, the procedure is very well tolerated by patients.


Other potential risks of DBS surgery occur after the system is implanted. There is a risk of infection, parts may wear through your skin, and the lead or lead-extension connector may move. DBS therapy could suddenly stop working because of mechanical or electrical problems. Any of these situations may require additional surgery or cause your symptoms to return.


Be sure to talk to your doctor about any questions or concerns you may have.