Deep Brain Stimulation (DBS) Treatment

What Is Deep Brain Stimulation (DBS)?

Deep Brain Stimulation (DBS) is a specialised neurosurgical procedure that involves the implantation of a medical device known as a neurostimulator. This device sends controlled electrical impulses through implanted electrodes to specific targets in the brain (the brain nuclei).

DBS is primarily used to treat movement disorders, including Parkinson's disease, essential tremor, and dystonia (in both adults and children). It is also an established treatment for conditions such as obsessive-compulsive disorder (OCD), Tourette’s Syndrome, and epilepsy.

Deep Brain Stimulation for Parkinson’s Disease:

Deep Brain Stimulation (DBS) is a surgical treatment used for Parkinson’s disease, especially when symptoms are no longer well-controlled with medication alone.

Parkinson’s disease is a neurological condition that affects the brain’s ability to control movement due to reduced levels of dopamine, a chemical that helps movements stay smooth and coordinated. Over time, this can lead to tremors, stiffness, slowness of movement, and unpredictable symptom fluctuations.

DBS works by delivering controlled electrical stimulation to specific areas of the brain involved in movement regulation. Thin electrodes are surgically placed into targeted brain regions, where they help regulate abnormal brain signals that cause Parkinson’s symptoms

DBS does not cure Parkinson’s disease, but for suitable patients, it can significantly improve symptom control, reduce medication-related side effects, and improve quality of life.

When is DBS Considered?

In the earlier stages of Parkinson’s disease, symptoms are usually managed with medication. Over time, however, some patients may experience:

Reduced effectiveness of medication
Shorter periods of symptom relief
Involuntary movements caused by medication (dyskinesia)
Unpredictable “on–off” symptom fluctuations (motor fluctuations).
Parkinson's tremor that is not well controlled by medications.
Side effects that limit medication use

When medication alone is no longer providing consistent symptom control, Deep Brain Stimulation may be considered as an advanced treatment option.

Who is Suitable for Deep Brain Stimulation (DBS)?

DBS may be considered for patients who:

Have a confirmed diagnosis of Idiopathic Parkinson’s disease.
Have other selected movement disorders, based on a specialist's assessment.
Respond to Parkinson’s medications but experience medication-related dyskinesia or unpredictable symptom fluctuations.
Have preserved cognitive function.
Have realistic expectations regarding treatment outcomes.
Have strong family or caregiver support.

Suitability is determined through a comprehensive specialist-led assessment.

How Deep Brain Stimulation May Help (And Its Limitations)

For suitable patients, DBS can offer meaningful improvements in daily life by providing better control over movement-related symptoms.

DBS may help to:

Improve Parkinson’s disease symptoms, including tremors, muscle stiffness (rigidity), and slowness of movement (bradykinesia).
Reduce motor fluctuations and minimize unpredictable symptom variations.
Decrease the need for Parkinson’s medications in selected patients.
Provide more stable and consistent symptom control throughout the day.
Improve quality of life and functional independence

However, it is also important to understand the limitations of DBS, such as:

Does not cure Parkinson’s disease.
Does not halt or reverse the progression of the disease.
Does not eliminate the need for ongoing medical care, monitoring, and follow-up.

Because outcomes vary from person to person, careful patient selection, realistic expectations, and long-term follow-up are essential parts of DBS treatment planning.

Pre DBS Work-Up & Evaluation

To ensure the best outcomes, patients undergo a thorough evaluation, including:

Levodopa ON-OFF assessment (Levodopa challenge), including pre-dose and post-dose UPDRS scores, Ham and Peg tests, gait analysis, and speech studies.
Video-graphic recording of symptoms.
Fitness for surgery assessment (Blood tests, ECG, and Chest X-ray).
3T MRI of the brain (performed with or without sedation/General Anaesthesia).
Neurosurgery consultation to discuss the surgery, implantable devices, risks, and post-operative expectations.
Neuropsychological assessment performed by a psychiatrist.

The DBS Screening and Assessment Process

Before DBS is considered, patients undergo a comprehensive evaluation to ensure the treatment is appropriate and safe.

This screening process typically involves:

1. Specialist Assessment

Patients are assessed by a neurologist (movement disorder specialist), who:

Confirms the diagnosis of Idiopathic Parkinson's and rules out Parkinsons like diseases such as Progressive Supranuclear Palsy (PSP) / Multiple System Atrophy (MSA) / Spinocerebellar Ataxia (SCA), or others.
Reviews symptom patterns and progression.
Assesses response to Parkinson’s medication
Identifies medication-related complications

2. Brain Imaging

Imaging tests such as MRI or CT scans are performed to:

Assess brain structure
Exclude conditions such as other brain lesions or Parkinson like diseases that are unsuitable for DBS.
Assist in surgical planning and target acquisition.

3. Cognitive And Functional Evaluation

Assessment of:

Memory and thinking ability
Emotional and psychological readiness
Ability to understand and participate in long-term follow-up

This step is important, as DBS is most beneficial in patients with preserved cognitive function.

4. Multidisciplinary Review

Findings are reviewed by a multidisciplinary team, which may include neurologists, neurosurgeons, imaging specialists, and DBS support staff, to determine overall suitability for DBS.

What To Expect: Deep Brain Stimulation (DBS) Patient Journey

Your DBS journey begins with careful planning and thorough evaluation to ensure the treatment is safe and appropriate for you.

Step 1: Evaluation Of DBS Suitability

Patients undergo a comprehensive assessment by specialists experienced in Deep Brain Stimulation.

This typically includes:

Assessment by a Neurologist specialised in DBS

Review of diagnosis and symptom profile
Brain imaging
Neuropsychological testing
Evaluation of response to Parkinson’s medication

Assessment by a Neurosurgeon specialised in DBS

Levodopa challenge to assess symptom response
Neuropsychological screening
Neurosurgical evaluation to determine surgical suitability

This structured process helps identify patients who are most likely to benefit from DBS.

Step 2: Surgical Implantation

If DBS is deemed suitable, the procedure is performed by a neurosurgeon (specialised in DBS) under local anaesthesia (stage 1) and followed under general anaesthesia (stage 2).

Stage 1: (done under Local anesthesia & sedation)

Electrodes are placed into targeted areas of the brain with frame-based image-guided, microelectrode recording and intraoperative neurophysiological assessment by a neurologist.

Stage 2: (under general anaesthesia)

A small neurostimulator (implantable pulse generator) is placed under the skin, usually in the upper chest wall.

Following surgery, patients typically undergo a recovery period of about 6 weeks before device activation.

Step 3: Programming And Optimisation

Deep Brain Stimulation does not achieve its full effect immediately.

DBS programming is usually performed by a neurologist specialised in DBS, approximately 6 weeks after surgery
Stimulation settings are gradually adjusted and personalised
Ongoing follow-up and fine-tuning help optimise symptom control over time (3 to 6 months).

Long-term care is an important part of successful DBS treatment.

DBS Surgery Timeline

Movement Disorder Neurology evaluation (pre-referral).
Comprehensive evaluation of medications and disease state.
Preoperative evaluation (Pre-DBS work-up): 2-day hospital admission.
DBS Surgery: 3-day hospital admission.
Frame application, target planning, and coordination of acquired imaging data.
Lead implantation with intraoperative neurological assessment and MER.
IPG implantation under General Anaesthesia.

Why Choose SJMC for Deep Brain Stimulation (DBS)?

At Subang Jaya Medical Centre (SJMC), Malaysia, Parkinson’s care is supported by neuroscience expertise, bringing together Neurology, Neurosurgery, and advanced brain technologies to deliver coordinated care for people living with Parkinson’s disease.

Deep Brain Stimulation is a specialised therapy that requires careful evaluation, precise surgical planning, and long-term follow-up. At SJMC, care is structured to support patients through every stage from assessment to post-surgery optimisation.

Patients can expect:

Care from a multidisciplinary neuroscience team, including neurologists and neurosurgeons experienced in DBS
Access to advanced diagnostic tools and brain imaging to support accurate assessment
A structured screening process to determine whether DBS is appropriate
Careful surgical planning followed by personalised programming
Ongoing follow-up and fine-tuning, which are essential for long-term symptom control
A strong focus on person-centred care, supporting both patients and their families

What To Do Next

If you or a loved one is living with Parkinson’s disease and symptoms are becoming harder to manage, Deep Brain Stimulation (DBS) may be worth exploring

Book a consultation with our neurologist for a comprehensive evaluation to determine whether DBS is suitable for you. Early assessment supports better treatment planning and helps ensure you receive the most appropriate care for your condition.

You may also learn more about our Neuroscience services to better understand the range of specialised care available for neurological conditions.

FAQs About Deep Brain Stimulation (DBS)

Deep Brain Stimulation (DBS) is not a cure for Parkinson’s disease and does not stop long-term progression, such as walking difficulties, imbalance, posture changes, memory decline, or speech and swallowing problems. However, DBS can significantly improve quality of life by increasing “ON” time (when medication works effectively), reducing tremor, stiffness, slowness, and decreasing dyskinesia. Some non-motor symptoms like pain, insomnia, and excessive sweating may also improve. Medication doses can often be reduced by 30–50%, though this varies. Clear understanding and realistic expectations are essential before proceeding with surgery.

No. DBS does not require frequent battery replacement. Some rechargeable models are designed to last for many years and may even last a lifetime, depending on the model and usage. Other models can last up to 10 years or more. Your doctor will advise which battery type is most suitable for your condition and lifestyle.

No. Battery replacement only involves changing the device under the skin (usually near the chest). The brain electrodes are not touched.

Yes, you can travel normally after Deep Brain Stimulation (DBS). However, please take note of the following:

Inform airport security about your implanted device
Bring your device ID card
Bring your charger if you are using a rechargeable system

Usually, only a small area of the scalp is shaved. A full head shave is typically not required.

In general, the amount of Parkinson's medications you take can be (gradually) reduced by 30-50% after DBS surgery, sometimes even more. However, it should be borne in mind that improved quality of life is the main aim of the surgery, not reduction in medication. In some patients, for reasons that are unclear, medication cannot be reduced by much.

Driving is only recommended after a year of DBS surgery and programming, though this varies.

After DBS surgery, some patients experience temporary symptom improvement due to a “lesion effect” (minor brain swelling at the electrode site), which may reduce medication needs for days to weeks. To allow this effect to settle, the DBS device is typically activated 4–6 weeks after surgery, once symptoms return to baseline. Programming is individualized, as responses vary; adjusting stimulation settings can take weeks to six months. The first session lasts 2–3 hours and is done in the medication “OFF” state. Several follow-up visits (usually 4–10) are needed to optimize settings. Once stabilized, DBS settings generally remain consistent for years.

Deep Brain Stimulation (DBS) is suitable for only about 10–20% of Parkinson’s patients. Ideal candidates are typically under 70 years old and show a clear difference between medication “OFF” and “ON” states, even if improvement is brief or complicated by dyskinesias. Some patients seek DBS mainly for troublesome dyskinesias. Careful assessment by a neurologist experienced in Parkinson’s disease and a skilled DBS surgeon is essential. DBS is now performed earlier in the disease course, as evidence shows it can be safe and effective before severe disability develops. Decisions should always be individualized based on each patient’s condition and overall health.

Deep Brain Stimulation (DBS), like any brain surgery, carries risks. The chance of a permanent neurological complication, such as stroke from bleeding during wire insertion, is low (about 1–2%). Therefore, DBS is usually not advised for patients with mild symptoms well controlled by medication. For those with poor quality of life despite multiple medications, the benefit-to-risk ratio is generally favourable. Other risks include speech worsening, infection (around 5%, sometimes requiring device removal), cognitive decline (mainly in those with pre-existing issues), and seizures (less than 5%). All potential risks and concerns should be thoroughly discussed with your neurologist and neurosurgeon.

Before DBS surgery, it is crucial to stop all Parkinson’s medications overnight. Longer-acting drugs (such as Trivastal Retard, Sifrol ER, and Requip PD) may need to be discontinued up to one week prior, as advised by your neurologist. Although this may cause temporary discomfort, it helps ensure accurate electrode placement, as doctors assess rigidity and its improvement during the procedure. Blood-thinning medications, including aspirin and certain traditional medicines or herbs, usually need to be stopped 3–4 weeks before surgery to reduce bleeding risk. Always follow your neurologist’s specific instructions carefully before the operation.

Unless there are complications, patients are generally discharged from hospital a day after the surgery. During the recovery period, you will have to take care to keep the surgical wounds (on the scalp and in the right upper chest region) clean and undisturbed. It usually takes around 1 month for the wounds to heal.

There may be a few precautions to consider after Deep Brain Stimulation (DBS):

The DBS battery is an electronic device that can conduct heat. Exposure to very high temperatures (such as in a sauna) should be avoided.
MRI scanners use strong magnetic fields that may potentially interfere with the implanted device. In certain situations, MRI scans may still be performed safely, but this must be discussed in advance with your neurologist and the device company support team. Other imaging tests such as X-ray, CT scan, or ultrasound are generally safe.
If diathermy (a heating instrument used to control bleeding during surgical or dental procedures) is required, special precautions must be taken. In some cases, a short course of prophylactic antibiotics may also be recommended to minimise the risk of infection spreading to the device.