Condition • Movement disorder

Deep Brain Stimulation for Parkinson's Disease

My approach, candidacy criteria, surgical targets, and realistic outcomes for Parkinson's patients.

STN / GPi target
EARLYSTIM evidence base
Honeymoon window concept
50–70% Motor improvement (UPDRS III)
30–50% Levodopa dose reduction
STN Primary target • GPi secondary

My Surgical Approach

Parkinson's disease is the condition I treat most frequently. DBS does not cure it, but it can give years of life back.

For the majority of my Parkinson's patients, I target the Subthalamic Nucleus (STN). STN DBS addresses tremor, rigidity, bradykinesia, and motor fluctuations simultaneously - and typically allows a reduction in levodopa dosage of 30-60%.

For patients with cognitive concerns, significant dyskinesia at low levodopa doses, or older age - I choose the Globus Pallidus Interna (GPi) instead.

When I Recommend DBS

✓
Motor fluctuations (wearing off) despite optimal medication
✓
Levodopa-responsive tremor / dyskinesia
✓
UPDRS motor improvement ≥30% on levodopa
✗
Significant cognitive impairment (MoCA assessment required)

Realistic Outcomes

  • Tremor: Typically reduces by 60-90% following STN DBS.
  • Motor Scores: ~50-70% reduction in UPDRS motor scores.
  • Medication: 30-60% reduction in levodopa equivalent dose.

What DBS does NOT improve: gait freezing (in some), speech/swallowing, balance, or cognitive symptoms. I discuss these limitations honestly.

DBS & Medication

DBS does not replace medication - it reduces the amount needed. I work with my neurologist colleague Dr. Hülya Mavi to gradually reduce dosages in parallel with programming optimisation.

Questions

Parkinson's DBS FAQ

Will DBS cure my Parkinson's disease?
No. DBS treats motor symptoms - it does not slow neurodegeneration. But in the right patient, it can provide years of dramatically improved quality of life.
Can I have DBS if I am 75 years old?
Age alone is not a contraindication. I assess each patient individually. Many of my most successful patients have been in their seventies.
How long does the benefit of DBS last?
Long-term studies show maintained DBS benefit for 10+ years. The device can be reprogrammed as the disease progresses.
Is DBS a last resort for Parkinson's?
No. Research shows that earlier DBS (EARLYSTIM trial) produces better long-term outcomes. Consider evaluation at the first signs of motor fluctuations.

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