Deep brain stimulation

The best candidates have a clear diagnosis, disabling symptoms despite good medical therapy, intact thinking, and stable mood. For Parkinson's disease, a strong response to levodopa is the single best predictor of benefit. DBS is not a last resort: waiting until medications have stopped working entirely usually means waiting too long. If you are asking the question, an evaluation is reasonable; "not yet" is a common and useful answer.

No. DBS treats symptoms. It does not slow or stop the underlying disease, which continues its own course. What it can do is give back a large portion of each day for years, and its settings can be adjusted as your condition changes.

For Parkinson's disease: tremor, stiffness, slowness, medication fluctuations, and dyskinesia typically improve. Balance, freezing of gait during "on" time, speech, memory, and mood usually do not, and speech or balance can occasionally worsen. For essential tremor, the target symptom is tremor itself. We will give you a personalized version of this list at your evaluation, in writing.

Three kinds. Surgical: about a 1 percent risk of bleeding in the brain (which can include stroke) and roughly 1 to 3 percent risk of infection. Stimulation-related: tingling, speech or balance changes that can usually be programmed away. Hardware-related: battery replacement on schedule and rare wire problems, which are fixable. We will review your individual risks in detail before any decision.

Not necessarily. We offer both awake surgery with brain-cell recording and fully asleep, image-guided surgery, and we were the first program in Texas to perform the asleep approach. Both are accurate in experienced hands; the choice depends on your condition, anatomy, and preference. Patients who are awake feel pressure and hear sounds but no pain, because the brain has no pain receptors.

Two stages. First, lead placement through a small opening in the skull, usually with one overnight stay. One to two weeks later, a short outpatient procedure places the pulse generator below the collarbone. Most people take it easy for about two weeks and avoid strenuous activity for four to six weeks. Stimulation is switched on a few weeks after surgery.

Usually reduced, rarely eliminated. Most Parkinson's patients take meaningfully less medication after DBS, which itself reduces side effects like dyskinesia. Plan on adjustments across the programming period rather than a single change.

Programming is the process of tuning your stimulation settings, and it is where much of the benefit is won. First programming happens a few weeks after surgery. Finding your best settings typically takes several visits over three to six months, and benefit can continue to build for up to a year. Tremor often responds quickly; dystonia improves more gradually.

Focused ultrasound treats tremor by creating a small permanent lesion with no incision and no implanted device: one procedure, no hardware, but not adjustable and not reversible. DBS requires surgery and a device, but it is adjustable, reversible, and treatable on both sides of the body. We offer both, so the recommendation you get is based on your situation, not on program capability.

This is exactly why every candidate has neuropsychological testing before surgery. DBS does not typically change who you are. Speech can be affected in some patients, and people with significant memory problems before surgery are at higher risk of worsening, which is one reason testing can lead to a "no" that protects you.

Largely normal. Modern DBS systems are MRI-conditional, meaning scans can be done under specific settings, and we coordinate that when needed. Airport security is fine: you carry a device ID card and request a hand search or walk through with precautions per the manufacturer. Most sports and exercise are fine once healed; we will go over the short list of things to avoid.

Non-rechargeable batteries last roughly 3 to 5 years depending on your settings and are replaced in a short outpatient procedure. Rechargeable systems last about 15 years and require regular recharging at home. We check battery status at every visit; running out unexpectedly is avoidable and symptoms return if stimulation stops, so we schedule replacements ahead of time.

Medicare and most private insurers cover DBS for its approved indications, including Parkinson's disease, essential tremor, dystonia, and OCD. Prior authorization is typically required, and our team handles that process with you.

First, we find out why. Underperforming DBS usually has an identifiable cause: settings that need reprogramming, medication interactions, a lead that is not in the ideal spot, or expectations that were set on the wrong symptoms. Most causes are correctable, and we run this troubleshooting for patients implanted here and elsewhere. Having DBS also does not disqualify you from future therapies.