What is Deep Brain Stimulation? How does DBS work? Deep Brain Stimulation for Movement Disorders – drkharkar

DBS is the short form of “Deep Brain Stimulation”. DBS is one type of Parkinson’s Surgery.

DBS works by passing a small current into the brain. This current is passed into only to a small part of the brain.

The doctor selects one out of two brain parts (either the GPi or the STN).

DBS works by changing the electrical currents in these areas. At present, we cannot mathematically calculate these changes.

But, empirically (as-seen-with-our-own-eyes) – DBS improves Parkinson’s symptoms.

Let us learn more about these topics:

What is Deep Brain Stimulation for Parkinson’s disease?

DBS is electrical stimulation of the brain by using a small machine. DBS can stimulate many brain areas.

DBS is actually approved for many diseases. It is not just a “Parkinson’s surgery”. It can be used for epilepsy and other movement disorders as well.

The basic setup is the same.

The DBS battery is inserted below the chest skin. Two small wires from the battery go up to the head. The wires go through the skull. They are inserted into the desired area of the brain.

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A DBS system – The battery/pacemaker is placed below the skin in the chest. The wire going inside the brain is called an “electrode”

For Parkinson’s disease: This target area of the brain is usually the “Subthalamic Nucleus (STN).

In some patients, another area is chosen as the target. This other area is the Globus Pallidus interna (GPi).

How is the target chosen? Read this article [Click here]

DBS can dramatically improve Parkinson’s symptoms. There are many before-after videos available on the internet.

For example, here is a video posted on youtube by the Neuromedical Center in USA.


How does Deep Brain Stimulation (DBS) work?

No one completely understands how Deep Brain Stimulation (DBS) works.

Doctors used to cut small parts of the brain to reduce Parkinson’s symptoms. This surgery is called a “tomy”, meaning “to cut”. For example, Thalamo-tomy, Pallido-tomy.

A small electrical current is used to stop small bleeds during surgery. This is called “electrical cautery”.

While doing this current, they noticed something odd. When they passed a current into certain brain parts, the Parkinson’s tremor disappeared!

Would it be possible to continue the stimulation indefinitely? This question led to the design of the DBS electrical system around 2000. DBS was approved for widespread use in 2002.


  1. “History & Future of Deep Brain Stimulation” Schwalb 2008: Fascinating article on how Deep Brain Stimulation for Parkinson’s was discovered (lots of pictures, free to read)


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DBS was invented by very, very smart and dedicated people.

Ah Yes!

So, it is one of those things where we don’t know how it works. But years of experience have shown us that it does. Like, complimenting your spouse…

Many researchers believe DBS stimulates the target. Some believe DBS actually causes the target to stop working.

The reality is complex, and as yet, out of reach.

Each of these targets (for example the STN) contain many millions of little cells arranged in very intricate circuits.

Basal ganglia circuits regulating movement
The circuits in each part of the brain are very complex. We don’t understand how they are affected by DBS.

Probably, the DBS current stimulates some of these cells, while other cells stop working. Some circuits go into overdrive, while others shut down.

This varying effect also varies according to the current characteristics, especially frequency.

The net effect is, at present, impossible to calculate mathematically.

Empirically though (with our own eyes), we see that when the stimulation is given at a high frequency – Parkinson’s symptoms decrease markedly.

What is the best theory for why DBS works?

Before starting, let me note that reading this part is not critical. It is very technical.

As noted before, we don’t really understand how DBS works. But there are numerous complicated theories.

Let us look at the simplest & most promising one, in relation to DBS of the most common target. The most common target is the Subthalamic Nucleus (STN).

First, let’s see what causes Parkinson’s disease.

  1. Usually, Dopamine keeps the STN in check.
  2. When Dopamine decreases, the STN runs amok (becomes hyperactive).
  3. This causes problems with movement – especially slowness. We recognize these as “Parkinson’s disease”.
STN: Without dopamine keep it under control, that pink little thing runs amok.

What happens when you put a wire into the STN and pass a high-frequency current through it?

  1. If you pass high-frequency electrical current into the STN, it cannot keep doing what it is doing. The fast electrical buzz causes it to go into “overload”.
  2. The part being stimulated (e.g. the STN) stops working.
  3. Gatekeepers in the brain (e.g. a part called the Thalamus) prevent the high-frequency electrical current from spreading to the rest of the brain. Thus, the rest of the brain keeps functioning well.

The other theories are a variation on this theme. Click here for a short table about these proposed mechanisms.

Some DBS effects cannot be explained by this theory.

Many symptoms including tremor and slowness decrease with high-frequency stimulation. But some symptoms like Freezing decrease with low-frequency electrical stimulation.

Why? We don’t know.

Therefore, there is a lot more to discover.

If the mechanism of DBS is not known, why should I consider it!?

Because it works.

Because it is quite safe.

There are many things for which we don’t understand the exact reason. For example, we are still finding out more about the myriad benefits of exercise.

For example – How does exercise improve Mood? We don’t understand that too well. But it is easy to grasp that exercise is good for you.

This what-you-see-is-true evidence is called “Empiric Evidence”.

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Exercise, even in short bursts, has tremendous benefits. We don’t mathematically understand the mechanism behind all these benefits.

So, Should I get DBS surgery for Parkinson’s?

“How does DBS work?” is a good question. “Should I get DBS?” is a separate question.

The success rate of DBS is quite high. If the patient is properly selected, most of them benefit from it. You can read more about DBS patient criteria here [DBS patient criteria].

In addition to the correct patient, the proper target (STN versus GPi) needs to be selected. [DBS location]

Most patients get at least 4.5 additional good hours. You can read more about DBS success rates by clicking here. [DBS success rate]

The risks of DBS surgery are low. You can read more about the risks by clicking here. [DBS risks]

One of the main barriers to DBS surgery is cost. Thankfully, it is cheaper to DBS surgery in India. You can read more about DBS cost in India and other specifics here. [DBS in India]


Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor's permission.
Dr. Siddharth Kharkar

Dr. Siddharth Kharkar

Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist.

Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

Call 022-4897-1800

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NeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar IconNeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar

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    Out patient is epileptic from about 10 years and her seizure gotten worse during the past year with the frequency of about 3-4 times a week.So we consulted … More Dr. Kharkar. He tried a few medicines, and within 1.5-2 months now the patient is feeling very well now. There are no seizures for 14 days currently.Dr. tried to keep medicines as minimum as possible. He also tried to keep the cost of the treatment minimum.When some of the medicines started showing side-effects, he was quick to switch the medicines to the better options.Overall I think we are getting a best of the available treatments. We thank you very much Dr. Kharkar.
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    Dr Kharkar is gem of a doctor with tremendous patience, empathy, genuine concern for his patients .He guides them very methodically & scientifically … More for their neurological ill healthOur epilepsy patient is extremely happy with his treatment , Patient feels better by just visiting him too!May his selfless service to humanity flourish to reach all the needy patients!!
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    I consulted Dr Sidharth for my sister who has become very hyper and aggressive and we could not understand the issue. Keeping in mind she is someone with … More special needs Dr Sidharth was extremely understanding of the situation and did not put her through unnecessary investigation and avoided a very long stay at the hospital. He was infact more keen on her returning home to her natural environment. We highly appreciate Dr Sidharth for his effort and for looking into the matter with utmost care. It was a very difficult decision for my family to get my sister admitted but we are glad we did it under his care.Thankyou Doc.
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    my name is prashant purohit. I m become completely bed ridden from last 9 months and was unable to walk. I couldnt find out the cause even after visiting … More many doctors and many hospital in Ahmedabad nd jodhpur.started losing hope. A good friend of mine suggested to visit a neurologist. After searching a lot, I came to know about Dr. Siddharth Kharkar and took his appointment in Nanavati Hospital. He examined and said that he suffered from \u201cPKD(PAROXYSMAL KNESIGENIC DYSKNESIA\u201c. He assured us to reverse this in 5 days time. And indeed this happened. I started recovering miraculously. today I am fully well fit I m walking as normal . Many Many thanks to Dr. Siddharth Kharkhar sir for giving me a new life.
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  • Avatar N N ★★★★★ a year ago
    We visited Dr. Kharkhar for treatment regarding my mum - who is a multi-stroke patient and has aphasia. Certain medications were creating complications … More with her condition and Dr. Kharkhar was able to help mitigate the issue. We found him and his approach to be incredibly compassionate, considerate, individualized and patient-friendly. He advice is astute, up-to-date and empathetic. His treatment always comes from a deeply human place and is about seeing how to help the patient and their caregivers feel more at ease. Something that is quite rare and refreshing within the medical community.We feel that he genuinely cares about the patients that he is treating and is always kind and respectful in his communication. Moreover, his admin team is very efficient and prompt and it's a pleasure to deal with them.Would highly recommend Dr Kharkhar himself - though we must say our experience with Nanavati hospital itself has been less than ideal.Hope this helps.
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    Exceptional experience with an expert,Dr. Kharkar is a knowledge house. It is rare nowadays to find doctors with patience, knowledge, and a flair for … More handling patient’s questions, besides Dr. Kharkar’s bedside manners are exemplary. I am privileged to be treated by such an amazing soul. I have told him and will repeat it here that “I am advancing my move back to India although I am a US Citizen, because I know I am in good hands and will be well taken care of. Thanks Dr. Kharkar for your selfless service!
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Noted as one of the best Neurologists in Mumbai

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Outlook India Magazine - 2021, 2023

Ex-Assistant Professor, University of Alabama, USA

Outlook India - Best neurologist in Mumbai