Parkinson's Treatment Part 2: Deep Brain Stimulation - Is Brain Surgery Really on the Table?

Quest Physio
Apr 1
5 min read

Part 2 of a 3-part series. Missed Part 1? Read: Medication — Meet Levodopa. Up next: Part 3 — Physiotherapy, Speech Therapy & OT.

Quick Answer: What Is Deep Brain Stimulation for Parkinson's Disease?

Quick Answer

Deep Brain Stimulation (DBS) is a surgical procedure involving a small implanted device — think cardiac pacemaker, but for the brain — that delivers continuous electrical impulses to specific brain regions controlling movement.

By modulating the abnormal signalling that causes Parkinson's motor symptoms, DBS can dramatically reduce tremor, rigidity, and 'off' periods, and often allows a significant reduction in medication. Most well-selected patients experience 30–60% improvement in motor scores. After subthalamic nucleus DBS, patients are able to reduce medications by around 50% on average.

Doctor using a tablet to explain to a patient the process of DBS for Parkinson's Treatment

Alright, let's address the elephant in the room — or more accurately, the neurostimulator in the brain.

When people hear "deep brain stimulation," reactions tend to fall into one of two camps. There's the "wait, they put something WHERE?" camp, and then there's the "I've heard about this — is it right for me?" camp. Both are completely valid. And both deserve a proper answer.

So let's get into it. Deep Brain Stimulation — more commonly known as DBS — is one of the most fascinating and effective treatments in modern neurology. It is not for everyone. But for the right patient, it is genuinely life-changing. Here's what the evidence says.

How Does It Actually Work for Parkinson's Treatment?

In Parkinson's Disease, the circuits that control movement start firing abnormally — overactive, dysregulated, and basically chaotic. This is what produces the tremor, stiffness, and slowness. DBS works by delivering a continuous, precisely calibrated electrical signal to interrupt that abnormal activity and restore more normal movement patterns.

Infographic showing how deep brain stimulation works for Parkinson's treatment

The device — called a neurostimulator — is implanted under the skin near the collarbone. Thin wires (leads) run under the skin to electrodes placed deep in the brain. The most common target is a structure called the subthalamic nucleus (STN) — a small but powerful region that becomes hyperactive in Parkinson's. Stimulating it essentially turns down the volume on that hyperactivity. The whole system is programmable and can be adjusted over time as the patient's needs change.

Who Is DBS Actually For?

The most suitable candidates are people with Parkinson's Disease who have motor fluctuations and/or dyskinesias not adequately controlled with optimised medication, or with medication-refractory tremor. During their best 'on' periods, gait difficulties, instability, and speech problems should be minimal — reflecting an excellent underlying response to levodopa.

In plain English: DBS works best for people whose symptoms respond well to levodopa — but whose medication is no longer providing adequate, consistent control. If levodopa doesn't help your symptoms much, DBS is unlikely to either.

Patients in the landmark EARLYSTIM trial were relatively young (mean age 52) with a mean disease duration of 7.3 years. Age alone isn't a barrier — research shows older patients can benefit without significantly higher complication rates. But DBS is only appropriate for idiopathic Parkinson's Disease — not atypical parkinsonism. Cognitive and psychiatric status must be carefully assessed beforehand.

What Does the Long-Term Evidence Say?

Over 30 years of DBS research has now accumulated, and the picture is encouraging — with some important nuances.

The good news: DBS consistently improves motor function, reduces 'off' time, decreases dyskinesias, and improves quality of life compared to medication alone. Non-motor symptoms also benefit — including mood, sleep, impulse control, and some autonomic functions.

The honest part: most studies report 30–60% improvement in motor scores. Motor fluctuations and dyskinesias remain improved at five years. However, quality of life scores can return toward pre-operative levels over longer periods — largely because DBS doesn't stop Parkinson's from progressing. The symptoms it can't address — balance, cognition, speech — continue to evolve.

DBS is not a cure, and it's not a pause button on the disease. But for the right patient, it offers a meaningful window of significantly improved function and quality of life.

The Exciting Frontier: Adaptive DBS

For the health professionals and curious minds in the room — here's where things get really interesting.

Traditional DBS delivers continuous, fixed stimulation 24 hours a day. The emerging technology is called adaptive DBS (aDBS), which adjusts stimulation in real time based on signals from the brain itself — a closed-loop system that responds dynamically to what the brain is doing moment to moment.

A 2025 study programmed eight patients with Parkinson's on commercially available adaptive DBS. Overall wellbeing significantly improved with adaptive DBS compared to conventional continuous stimulation. It's not yet standard practice everywhere, but it represents the direction the whole field is heading — personalised, responsive, smarter stimulation.

What About the Risks?

Any honest discussion of DBS has to include this. It is brain surgery — and that comes with real risks, including bleeding, infection, lead misplacement, and device complications. The risk of serious adverse events is low in experienced, high-volume centres — and outcomes are consistently better at centres that perform a high volume of these procedures.

This is why a comprehensive multidisciplinary assessment before surgery is non-negotiable — involving a movement disorder neurologist, neurosurgeon, neuropsychologist, and psychiatrist.

Patient expectations also matter enormously. Having a clear, realistic understanding of what DBS can and can't do before surgery is part of what makes outcomes good.

Couple making a decision with their neurologist on using Deep Brain Stimulation for Parkinson's Treatment

What This Means for You

DBS is one of the most remarkable treatments in modern neurology. For people with advanced Parkinson's experiencing significant, medication-resistant motor fluctuations or tremor, it offers a level of improvement that medications alone can't always provide. The evidence base is strong, the technology is advancing rapidly, and for the right patient — the outcomes can be extraordinary.

Is it right for you or someone you care for? That's a conversation for your neurologist and a specialist movement disorder team. But knowing it exists, knowing what the evidence says, and knowing who it suits — that's a great place to start.

Next up in our series: the treatments that don't involve a scalpel, but arguably change daily life just as much. Part 3 is all about physiotherapy, speech therapy, and OT — and trust us, you'll want to read it.

At Quest Physio Chermside, we work with people living with Parkinson’s at all stages — including those considering or preparing for advanced treatments like DBS. Our role is to help you stay strong, mobile, and confident before, during, and after any medical intervention.

If you’d like guidance on what the next step could look like for you or someone you care for, we’re here to help.

📞 Call (07) 3088 8035 or visit questphysio.com.au to learn more or book an initial assessment.

This blog is for general educational purposes only and does not constitute medical advice. Please speak with your neurologist, GP, or allied health professional for personalised treatment advice.

Written by Julius Alpay, Physiotherapist