The idea of brain surgery is enough to make anyone nervous. And if your doctor has recommended deep brain stimulation (DBS), it’s normal to have many questions about what the procedure involves.
Deep brain stimulation uses thin wires placed in specific areas of the brain to deliver electrical signals that help control symptoms of conditions like Parkinson’s disease, essential tremor and epilepsy. Unlike some other brain procedures, it doesn’t involve removing or destroying brain tissue.
“It’s completely normal to feel nervous when you first hear the words ‘brain surgery,’” says Hyun Joo Park, MD, a neurosurgeon with the Ayer Neuroscience Institute at Hartford HealthCare. “But once patients understand that DBS happens in clear, carefully planned steps, it often starts to feel much more manageable.”
Here are seven things you should know about DBS.
1. It starts with a careful evaluation
Before surgery, your care team will make sure DBS is right for you.
“We want to know which symptoms are affecting your life most and which ones DBS may actually help,” explains Dr. Park.
Your evaluation might include brain scans, a review of your medications, as well as tests of your movement, memory, thinking and emotional health.
“DBS works a bit like a pacemaker for the brain,” she adds. “A small device under the skin of the chest sends electrical signals through leads placed in specific areas of the brain.”
How DBS might help depends on your condition:
- Parkinson’s disease: Improves tremor, stiffness, slowed movement, involuntary movements and “on/off” periods. It may be considered when medications aren’t working well or cause difficult side effects.
- Essential tremor: Helps control shaking when medications no longer provide enough relief.
- Dystonia: Reduces involuntary muscle contractions, twisting and tremor.
- Epilepsy: Helps regulate abnormal electrical signals and reduce seizures.
- Severe OCD: An option when symptoms haven’t improved enough with medication or other treatments.
> Related: 5 Myths About Deep Brain Stimulation
2. The first surgery places the leads
The first surgery places one or two thin leads in carefully selected areas of your brain.
“This is very precise work,” says Dr. Park. “We use imaging and multidisciplinary team discussions to choose the location based on your condition, anatomy and symptoms. During surgery, we use a small electrode to listen to electrical signals in your brain and confirm that the lead is in the right place. We also briefly wake you up and test the stimulation to see how your symptoms respond. Your scalp and other areas that can feel pain are numbed, and the brain itself doesn’t have pain receptors.”
After the leads are in place, your care team connects them to the device that delivers stimulation.
“The plan is personalized from the start,” she adds. “There isn’t one target that’s right for everyone. The area we target depends on your diagnosis and symptoms, so someone with Parkinson’s disease may need stimulation in a different part of the brain than someone with essential tremor.”
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3. You may be awake or asleep
Many people wonder if they’ll be awake during surgery.
“Some DBS procedures are performed with you awake for part of the surgery, while others are performed under sedation or general anesthesia,” says Dr. Park.
If you’re awake, your scalp will be numbed and your team may ask you to speak or move your hand. If you’re asleep, imaging will help guide the procedure.
“Either way, your team will keep you comfortable and supported throughout every step of this procedure,” she adds.
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4. The battery may be placed at the same time or later
Depending on your treatment plan, the battery-powered device may be placed during the same surgery or at a later time.
“This part is done under general anesthesia,” says Dr. Park. “The device sits under the skin of the chest and connects to the leads.”
The device might create a small bump under your skin, similar to a pacemaker.
“By this point, the leads are already in place,” she adds. “This step completes the system so we can move toward programming.”
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5. Programming is part of the treatment
DBS treatment continues after surgery.
“After you heal, we start programming the device and adjusting the stimulation based on how your symptoms respond,” says Dr. Park.
It might take several visits to find the settings that work best for you, and your team can keep adjusting them as needed.
“It’s a process of fine-tuning, not getting one setting perfect on the first try,” she adds.
> Related: Essential Tremor: The Most Common (And Least Known) Movement Disorder
6. The changes can look different for everyone
Most people don’t feel the stimulation itself. Instead, they notice changes in the symptoms that DBS is meant to help.
“What improves depends on the person,” explains Dr. Park. “For some, tremor is the biggest issue. For others, it may be stiffness, slowed movement or medication-related off periods.”
Programming can sometimes cause temporary side effects like tingling, changes in speech or balance problems.
“If something doesn’t feel right, tell us,” she adds. “We can often adjust the settings.”
> Related: 6 Early Symptoms of Parkinson’s
7. DBS can help symptoms, but it isn’t a cure
DBS can help manage certain symptoms, but it doesn’t cure the underlying condition or prevent it from changing over time.
“The goal isn’t to make every symptom disappear,” says Dr. Park. “It’s to focus on what DBS can realistically improve and what that could mean for your daily life.”
Some people are able to reduce certain medications, while others might need to keep taking them.
“This is a decision we make together,” she adds. “Our goal is to decide if DBS could help make the symptoms that matter most to you easier to manage.”
