What is Deep Brain Stimulation? How does DBS work?

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

near LIC, Dr Balabhai Nanavati hospital, near LIC, Swami Vivekananda Road, LIC Colony, Vile Parle

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  • Avatar Paras Prabhu ★★★★★ 5 months ago
    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.
  • Avatar Sanjay Pradhan ★★★★★ 5 months ago
    Dr. Kharkar is truly exceptional. He is extremely knowledgeable. But simultaneously, he is extremely patient and kind - taking the time and care to respond … More to all the questions. It is rare to come across a doctor who is not in a hurry to get on to the next patient, but instead, focuses on the one in front with full attention, expertise and compassion. A great experience.
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    I have been visiting Dr Kharkar for treatment of my father. He is a very friendly doctor. He listens to our concerns with lot of patience. He also explains … More the issue in much greater details. He has really been of great help. My father is much better now.
  • Avatar N N ★★★★★ 5 months 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.
  • Avatar Vineet Badhwar ★★★★ 3 months ago
    One of the best doctors in Mumbai,listen to patients with concern very helpful, takes advise of other doctors very seriously. Examines the disease very … More carefully and advises patient of the medicine accordingly . Over all a good human being.
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    Dr Kharkar gives you all the time you need to hear you out in complete detail. He probes in depth to ensure he has managed to gain all data points to find … More the best way forward medically for you. He is an authority on the subject. After 4 years of suffering I have found my go to doctor
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    One of the best Dr. Gives complete attention and time to listen to patient's history, issues. Explains various options of treatment with pros and … More cons.
  • Avatar Lawrence Castellino ★★★★★ 6 months ago
    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!
  • Avatar Hemant Kansara ★★★★★ 8 months ago
    Great doctor!! Really appreciate.The doctor diagnosed to my sister correctly and start treatment, she has good improvement after taking medicine prescribed … More by doctor as no epilepsy attake. We have good experience with the doctor. Thank you
  • Avatar Anil Chinchulkar ★★★★★ 8 months ago
    We have visited the hospital and meet the Dr. S. Kharkar. And my personal experience is very much better and exilent. My father is very well recover as … More we thought. Thanks to Nanavati Hospital and Dr. S. Kharkar.
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    The services that I received from doctor Siddharth kharkar is excellent ,and the other doctor is also very good who had taken initial discussion with me … More ...and the staff are friendly and ensure that I am properly informed about my health and care and would highly recommend to anyone..
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    Had very Severe migraine attacks for years and suddenly my migraine had triggered for continuous 5 days thats when I contact Dr Siddharth and was fortunate … More to have a effective medication which help me reduced my triggers and headaches..Lucky in few months I have very less days of headache in a month and can do my Daily life with much ease.
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    My experience with Dr Siddharth Kharkar was really awesome. It’s always great to be in the presence of someone who is a renowned expert in his field & … More it brings peace of mind that the advice will obviously be the correct one. In addition, his ability to convey complex workings of the human brain in such simple terms that a layman like me could easily understand was something I really appreciated. I heartily Thank Dr Kharkar for his astute advice & gladly recommend him to anyone who needs a neurologist.
  • Avatar Rohit shetye ★★★★★ a year ago
    Best Dr. we have ever meet. Dr. Listened to us patiently and gave us the proper solution. No unnecessary test or didn’t frighten us. Thank you so much … More Dr.
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    Great doctor!! Really appreciate.The doctor diagnosed me correctly and start treatment that will help me a lots to improve my condition. The doctor is … More really good, calm and his nature is down to earth, gives confidence to patient!!! Thank you!!!
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    We had been looking for a specialist in parkinsons for a while now, for my father and when we found Dr. Siddharth Kharka's details on Google, we were … More partly relieved. Partly because, we were all very anxious not knowing how would our visit turn out. I appreciate Dr. Kharkar and his team. He was very clear in his explanations, his knowledge about parkinsons. He took the time to answer the questions we had, went over the diagnosis and started necessary treatment immediately. The only drawback we experienced was the waiting time. Overall, we left the clinic satisfied, knowing much more than when we walked in. We would highly recommend him to anyone looking for a specialist.
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    I have visited the doctor clinic for the first timeBut he gave good advice and helped me overcomeMy doubts and queries. It was a good experience.I am very … More thankful for cooperation.
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  • Avatar Krishna kumari Radhakrishnan ★★★★★ a year ago
    Hi Sharing my experience with Dr KharkarI had consulted with dr regarding my husband’sProblems of tremors. Dr immediately diagnosed on video consultation … More and could help him to control the tremors s of Parkinson’s disease.I found him genuinely polite and free to talk n patiently listening to the patients problem.Now my husband regained his balance n tremors controlled. Many many thanks to Dr Kharkar
  • Avatar a kumar ★★★★★ a year ago
    Dr kharkar is very nice doctor, sir explained each and every thing very nicely, and i am thankful for Dr kharkar for his treatment .
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    I had a positive experience with the doctor. He was very sympathetic. His communication skills were good and listened with patience.
  • Avatar Ujwala Sawant ★★★★★ a year ago
    Because of Dr.kharkar sir my husband got new life. Tnx sir.
  • Avatar Mythili Balasubramanian ★★★★★ a year ago
    Consultation with the doctor was a very satisfying experience. Was empathetic in his approach, and responded positively to all the queries we had. Thank … More you doctor!
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  • Avatar Sharmila Kumawat ★★★★★ a year ago
    Dr Siddharth is one of the best Dr I have ever met. He is kind, polite, helpful and very selfless person. I have migraine and I am his patient since more … More than 2 years. The staff is always helpful and Dr Siddharth is just beyond words for me. Thank you for ur selfless service and kindness u give to all ur patients.

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India Today Magazine - 2021Noted as one of the Best Neurologists in Mumbai