Deep brain stimulation (DBS) is a type of neurostimulation, meaning a treatment that uses small electrical signals to help change how certain brain circuits behave.¹,² DBS therapy uses an implanted brain stimulator system that a specialist team can adjust over time to help manage specific symptoms.¹–³ Is DBS the same as brain surgery that removes or destroys tissue? No. DBS is a surgery, often considered "minimally invasive," that places thin electrodes in the brain and connects them to a device under the skin, but it does not remove brain tissue the way lesioning procedures do.¹–³ That difference matters to most people because DBS settings can be adjusted after surgery, and stimulation can be turned off if needed.¹–³ Does DBS send electricity all the time, and can it be changed? DBS uses programmed electrical pulses, and those DBS settings can be adjusted during follow-up visits and sometimes by you as the patient through your controller and battery/generator.¹–³ This is why DBS programming is often described as part of the treatment, not as an afterthought, because finding the best settings can take time.²,³ For some conditions, such as essential tremor, these changes are seen immediately, and with some conditions, like Parkinson's, it can take longer to see results. So, if DBS is "adjustable," does that mean it is "reversible"? DBS is often called "adjustable" and, in many cases, "reversible" in the sense that stimulation can be reduced or turned off.¹–³ Still, the system is implanted, and implantation involves surgery, so it is not a simple on-off decision like changing an app setting.²,³ Also, if you as the patient, along with your medical team, find you are not getting the best therapeutic results from DBS and its programming, you can have another procedure called "Focused Ultrasound (FUS)," at which time they would have to surgically remove the electrodes and battery. FUS is typically considered the last-case therapeutic treatment as it's not reversible and permanent. What does DBS feel like? Will I feel electricity in my head? Traditionally, you won't feel stimulation as a "shock."²,³ Some people have noticed sensations during programming, such as tingling, pulling, speech changes, or balance changes, which can sometimes be improved by adjusting DBS settings.²,³ Also, you may feel what some patients call a "swoosh," where it's almost like riding a rollercoaster when increasing or turning on and off the DBS system. This is normal! Again... this is normal, but not always typical. It doesn't hurt, and some patients even look forward to it as the "fun part." It lasts only for 1 second, and doesn't hurt! Sometimes, when programming is done by your medical team, it can be programmed too strongly, at which point you may feel the electricity in your lower jaw. This doesn't happen with every patient or with every medical team, but we want to share all possibilities! Is DBS a "last resort"? Quick answer - NO! As mentioned in an earlier question, DBS is not the last resort, and that last resort is traditionally considered to be Focused Ultrasound (FUS). DBS is typically done when symptoms aren't controlled with other treatments, such as pharmacological options, or when side effects from those treatments are limiting daily life.²,³ Whether it's the right step is a shared decision between you and your medical team. That decision is dependent on your goals, your health, and what matters most day to day to you.²,³ You are your own best advocate. Ultimately, every decision will be yours, along with your own personal DBS education and guided by your medical team! Will DBS replace my medications? Sometimes medications can be adjusted after DBS, depending on the condition being treated with DBS and in consultation with your medical team. In some conditions, DBS is used because medications DON'T work, but many people still use medications, often in different or reduced doses or schedules.²,³ Planning for DBS works best when it includes realistic expectations about ongoing care, including follow-up and medication review.²,³ Those are conversations you will have with your medical team! What are the main DBS risks and side effects? Firstly, we don't like the term "side effects." We choose to use the term "ripple effects" because just like throwing rocks into a pond... ripple effects can create unexpected concerns. However, when you have more rocks thrown in that same pond, those other ripple effects can affect how all of the other ripple effects positively, and potentially negatively, affect your care. That's why open communication with your medical team is so important. They can't help you if you don't communicate with them! They are YOUR team! Now, DBS does have great benefits, but it also has potential "ripple effects." Like with any surgical procedure, risks are there. These can include infection, bleeding in the brain, stroke-like complications, seizures, and problems with wound healing.²,³ Stimulation-related ripple effects can include speech changes, tingling, muscle pulling, mood changes, or balance issues, and these may improve with DBS programming changes.²,³ What is the difference between a "ripple effect" and a "complication"? This is such a great question! Traditionally, a side effect is an "unwanted effect that can happen from stimulation settings, and it may improve when settings change."²,³ A complication, however, is a broader problem that can come from surgery or the implanted hardware, such as infection or bleeding, and it may require medical treatment.²,³ However, each individual is biologically unique! What one person may experience is different from what another person may experience. Not everyone will experience the same ripple effects during or after surgery. Some never experience ANY issues! Again, this is why it is important to remain your own best advocate with a direct line of communication with your medical team! Tell them about both any "ripple effects" and "complications" you may experience! Is DBS available everywhere, and is it the same in every country? Availability, approved indications, and device options can differ by country and health system.⁴,⁵ If you live outside the United States, it is reasonable to ask your medical team who approves and regulates what conditions DBS is approved for and used in. Even in the United States, there are some conditions not approved by the FDA but are used as a valid therapy on a case-by-case basis. For instance, most movement disorders are FDA approved; however, many conditions such as treatment-resistant depression, pain, or epilepsy are used when nothing else has worked. Uses are locally approved or commonly offered.⁴,⁵ When should I seek urgent or emergency care? Seek emergency care right away if symptoms are severe or sudden, especially signs of stroke (new one-sided weakness, face droop, sudden trouble speaking), a sudden worst headache, fainting, prolonged seizures, or rapidly worsening swelling, redness, drainage, or fever that could signal infection.²,³ If something feels urgent, it is safer to be evaluated immediately.²,³ Always keep your medical team's number on speed dial!

Just as with any "system," there are "parts." And just like many systems, they only work as well as how the individual parts are designed to work with each other. A Deep Brain Stimulation system is truly the case where the "Sum is Greater than the Parts!" Why are there "parts" at all? DBS therapy works through an implanted brain stimulator system, so it has several connected parts, each with a job to do.¹–³ The system is truly a "sum of its parts" that all work together to provide the best therapeutic value you can have with consultation from your medical team. What are the main implanted parts of a DBS system? Most DBS systems have three main implanted parts: (1) the brain lead (also called an electrode), (2) the extension wire that connects everything under the skin, and (3) the implantable pulse generator, also called the IPG or neurostimulator, which is the "battery and computer" that creates stimulation.¹–³,⁵ Note: Often the phrase "Implantable Pulse Generator (IPG)" is also called the "Battery" or the "Generator." All three of these terms are interchangable and used by patients and medical teams for the same part of the DBS system. What is a DBS lead, and what does it do? A DBS lead is a thin, insulated wire placed into a specific brain target during DBS surgery.²,³ The tip of the lead has metal contacts (small points that deliver stimulation), and the care team can choose which contacts to use as part of DBS programming.²,³ What is the extension wire? The extension is an insulated wire tunneled under the skin of the head, neck, and shoulder area to connect the brain lead to the IPG in the chest (or less commonly another location chosen by the surgeon).¹,² What is the IPG, and where is it placed? The IPG, implantable pulse generator, is usually placed under the skin near the upper chest, often below the collarbone.²,³ The IPG generates electrical pulses that travel through the extension and into the lead.²,³,⁷ Sometimes the location will be varied (either left or right side) to meet your desire as the patient, or where your neurosurgeon prefers, or in case you have two DBS systems installed (example: treatment-resistant depression and pain), and lastly if you already have a pacemaker installed! Are DBS batteries always the same, and what is "DBS battery replacement"? DBS systems can be nonrechargeable or rechargeable, depending on the device, what your insurance will and will not cover, all in conjunction with what your medical team recommends.⁴,⁶ With nonrechargeable systems, DBS battery replacement means a planned procedure to replace the IPG when the battery reaches its end of service, typically at the most 5 years.³ With rechargeable systems, people recharge the IPG regularly using an external charger, and replacement timing can still vary over the long term, and often find 10 to 15 years of life before needing to be replaced.⁴,⁶ What parts are "outside the body," and why do they matter? Many DBS systems also include external tools such as a patient controller, which also typically includes a bluetooth connector to the battery, and a clinician specific programmer.⁴,⁶ The patient controller can be used for limited actions your team allows, such as checking device status or using approved options like turning therapy on or off, depending on the system and your care plan. Some patients are also trained by their medical team to increase or decrease the millivoltages themselves, which is ultimate freedom of care!⁴ The clinician programmer is used by trained clinicians to set and adjust DBS settings during visits.⁴,⁶ This clinician programmer is often controlled via a smart tablet (like an iPad or Android tablet) and varies per manufacturer. There's not a consistency across manufacturers. What is a charger, and who needs one? Rechargeable DBS systems use an external charging system to recharge the IPG through the skin.⁴,⁶ Some systems include charging accessories that help hold the charger in place during charging.⁶ These often look like a shawl where a counterbalance is put on one side, and the other side has the recharger "puck" that fits in a pocket that will lay on top of where your battery/generator is and charges via conduction. You will feel nothing while the charging is happening, maybe a light warmth, but nothing that would alarm you. Also, this puck that recharges will come with a charger itself to recharge. When you recharge is a discussion you have with your doctor and dependent on your programming. Some find a weekly shorter recharge on their battery/generator works for them, while some opt for bi-weekly or monthly recharging. If your battery/generator is on 24/7, you may need to recharge weekly. Some who turn off their DBS system at night may only need a monthly charge. Weekly charges typically are the length of your favorite 30-minute TV episode. What are the "anchors," "burr hole covers," or other small hardware pieces? Some DBS systems use small surgical accessories to secure the lead where it passes through the skull, helping keep it stable after implantation.⁵,¹² The exact hardware can vary by surgeon technique and device system.⁵,¹² These often look like a button that is screwed into the skull, with a closure where the lead comes out of the brain, down the scalp to the connector behind, typically, the left ear. That will differ if your battery/generator is put on the right side. Also, both leads will go to the same connector behind the ear. You can feel these buttons/covers in the scalp and often see them; however, if you grow your hair (which is small areas shaved in most cases before surgery), they are hidden from view. What does "DBS programming" actually adjust, and is that part of the device? Programming is not a separate implanted part, but it is a key part of how the DBS system is used. Your medical team will work with you to adjust your DBS settings, for example, which lead contacts and which of the four ports in each lead are active and how stimulation is delivered—to balance symptom relief and side effects.²,³,⁴ The great thing about this programming is that it is unique to your specific needs. More to come on this! What is "DBS MRI safety," and how does it connect to the device parts? MRI safety depends on the exact DBS system components you have and the MRI conditions listed for those components.⁹–¹² Some systems are labeled MR Conditional, meaning MRI can be done only under specific conditions,⁹,¹² and many battery/generators can be programmed with an actual MRI Mode that you can switch to in case of an MRI, CAT scan, and X-ray. Because conditions vary by manufacturer, device model, and how the system is configured, it is important to coordinate any MRI with the clinician who manages your DBS.⁹–¹² Note: If you don't turn off in the instance of imaging, some manufacturers have a default where the battery/generator will automatically power itself off to protect you and the device. Also, you will get a card for your wallet from your manufacturer that acts as a "get out of jail free card" in the event you go through scanning devices like at TSA airports and at concerts where a security wand is used. Flash your card and you are good! Do the parts of a DBS system differ by country? Yes, sometimes. Device options, labeling, and what is commonly available can differ by country and health system. If you live outside the US, ask which DBS systems are available locally and how follow-up, replacement, and MRI policies work in your region.⁶,⁹ All DBS systems are CE rated, but that doesn't mean they are available and approved where you live. Ask your medical team what they use! What are common DBS issues and ripple effects tied to the hardware? DBS risks and ripple effects can relate to surgery, the implanted hardware, or stimulation.²,³ Hardware-related issues can include infection, discomfort at implant sites, or problems that require medical evaluation.²,³ Stimulation-related side effects can often be improved by adjusting DBS settings, depending on the situation.²,³,⁴ Again, everyone is unique and individual, and you may not experience any problems. This is where you have conversations specific to your own biology, lifestyle, and concerns with your medical team! Note: Seek emergency care right away if symptoms are severe or sudden, such as signs of stroke (new one-sided weakness, face droop, sudden trouble speaking), a sudden "worst headache," fainting, prolonged seizures, or rapidly worsening swelling, redness, drainage, or fever near an incision or device area that could signal infection.³,⁵ If something feels urgent or severe, it is safer to be evaluated immediately.³,⁵

Sometimes, trying to understanding how Deep Brain Stimulation works can feel overwhelming, but it doesn't have to be! Think of your brain like a complex highway system where signals travel through different routes to keep everything running smoothly. When those routes get disrupted, symptoms can appear. DBS therapy works by helping to clear the traffic jams and restore smoother communication within those pathways. Let's break down how this all works in plain language, so you can better understand what's happening in your own unique brain! What does "brain circuits" mean, in plain language? A brain circuit is a group of connected brain areas that work together like a team. Signals in your brain move all throughout like circuits in loops, like traffic flowing through familiar streets and intersections. When the timing in that loop gets off, then symptoms can show up.⁴,⁵ Which brain circuits are most often discussed with DBS? Many DBS "targets" (areas of the brain where the electrodes end up being put) are part of a movement network that connects the basal ganglia (a set of deep brain structures), the thalamus (a relay hub), and the cortex (the brain's outer layer that supports movement planning and control).⁴,⁵ These loops help the brain start, stop, and smooth movements.⁴,⁵ So, what goes "wrong" in a circuit when symptoms appear? In some conditions, parts of a circuit can start firing in patterns that are too synchronized, too noisy, or poorly timed.⁴–⁷ A common way researchers describe this is abnormal rhythms (also called oscillations) that can crowd out clearer signals. Think of this like static on your car radio!⁶–⁸ You have to dial in the station to be as clear as possible to get the best result from the station you want. Remember how you would change the channel on your car radio, and you are trying to tune into fictional tradio station "WDBS 101"? It may be kind of fuzzy to listen to because you are tuned into 100.5 or 101.3, when it's most clear at 101! Does DBS "turn off" a brain area? No, not exactly: DBS doesn't work like a simple "off switch." Medical researchers describe DBS as changing the pattern of information flow in a circuit, sometimes disrupting or "jamming" abnormal signals so the circuit can function more smoothly.⁶,⁷,⁹ It's like clearing out those signals that are noisy... so that you can hear radio station 101 clearly! What is a leading scientific thought for how DBS helps different health symptoms? One well-known hypothesis is that DBS disrupts abnormal information flow through a problem area that separates what comes into that area from what goes out. This prevents the bad patterns from spreading through the whole circuit loop!⁶,⁷ This also helps to explain why DBS can reduce certain symptoms even though the exact biology can differ across conditions (like movement disorders and neuropsychological) and targets (areas in the brain where the electrodes go).⁶,⁷ What are "Beta Oscillations," and why do people mention them with Parkinson's? Beta oscillations are a type of brain rhythm. Specifically in Parkinson's disease, higher or more persistent beta activity in parts of the movement circuit is typically associated with feeling stiff and slower than normal, and DBS therapy can reduce beta activity in those specific targets.⁸,¹⁰ This is one reason beta signals are often studied as a marker of how the circuit is behaving.⁸,¹⁰ Why does target choice matter if it is all "one circuit"? This is such a great question! A "circuit" is like a loop with multiple stops. Stimulating one stop can change the whole loop, but not always in the same way.⁴–⁷ Different targets connect to different pathways, so the best target depends on the condition and the symptoms being targeted.⁴,⁵,⁷ This is also the reason that what works as therapy for one condition, like Parkinson's, wouldn't work the same way for someone with treatment-resistant depression! Different parts of the brain uniquely help different conditions! Again, this is where your unique biology comes into play because even though one person with Parkinson's gets a therapeutic value in the same circuit region, another patient with Parkinson's may be 1 to 2 mm off in another area of the same circuit! What do DBS programming and DBS settings change in the circuit? This is where the cool part of DBS therapy happens. Everyone's programming is different and unique to their own body! DBS programming changes your unique DBS settings, such as which of the 4 contacts on each electrode are active and how the stimulation (millivoltage) is delivered.²,³ These unique settings can shape how much, where, and when stimulation enters your circuit, which can positively influence both symptom relief and side effects.²,³,⁷ This gets back to the positive role of ripple effects! Changing these frequencies when you experience negative ripple effects can remove the negative ripple effects! It's a fine dance that is uniquely your own! Why can DBS help one symptom but not another? Because you are biologically unique from every other person with DBS, you may feel different symptoms coming from different parts of your own circuit or from brain changes outside the circuit that DBS is influencing.⁴,⁵ DBS can be very effective for certain symptoms, but it does not repair all brain changes, and it does not stop disease progression.²,³,⁵ It's probably best compared to a medication that often needs to be increased or changed to positively affect the symptoms of your condition, disorder, or disease state. If DBS changes circuits, why is the mechanism still described as "not fully understood"? DBS affects multiple things at once: local brain cells, nearby fibers and neurons (wires of communication), and the wider electrical brain network.⁶,⁷,¹¹ Because of that, DBS is better understood as "circuit modulation," not a single solitary action! Medical researchers continue to study why one person responds strongly, another responds modestly, and how to make therapy more precise.⁶,⁷,¹¹ This is the importance of studying not just DBS therapy, but the condition, disorder, and disease state treated! Research for DBS for Parkinson's is different from DBS for treatment-resistant focal epilepsy and DBS for addictive disorders! What is adaptive DBS, sometimes called "closed-loop DBS"? Traditional DBS usually delivers stimulation in a steady way based on programmed settings.²,³ Most DBS systems today are bi-phasic, meaning they send millivoltage and receive data on its effectiveness, but the programming in the battery/generator where all the programming lives isn't set up to receive data and automatically make changes "on the fly." For instance, if your programming needs to increase in times of stress, it won't automatically happen. You or your medical team have to manually increase or decrease the therapy. With adaptive DBS, which is a form of closed-loop DBS, it takes the data and brain signals FROM the area and automatically adjusts stimulation over time to match the therapy to what you need in that moment.¹²,¹³ Availability and eligibility vary by country and by device system, so it is reasonable to ask your clinician what options exist where you live.¹²,¹³ Currently in the United States, the Medtronic Percept DBS system is only approved for Parkinson's. At this time, no other manufacturer or condition is approved. We hope that will change soon for patients' sake! Is "how DBS works" the same everywhere in the world? The best answer would be yes; however, the reality is . . . no. The core idea of this "circuit-based neurostimulation" is somewhat consistent, but devices and features, like sensing, along with which treatment symptomatic indications are approved (such as Adaptive for Parkinson's with only one FDA approved manufacturer in the United States), differ by country and health system.¹,²,¹² This is why you have the important conversations with your medical team about which DBS systems are best for your therapy, available locally, and how follow-up and device features work in your region.²,¹²

Deep brain stimulation (DBS) “targets” are the specific brain structures where the electrode tip is placed. Different conditions use different targets because each target sits inside a different brain circuit, like choosing which breaker switch to adjust in a house. Some targets are part of FDA-approved or FDA Humanitarian Device Exemption (HDE) labeling in the US, and others are commonly treated in specialty centers or studied in clinical trials and research.¹⁻⁵ FDA-approved and/or HDE DBS targets in the United States (by treated condition) • Essential tremor, and tremor associated with Parkinson’s disease • Ventral intermediate nucleus of the thalamus (VIM)¹ ⁶ • Parkinson’s disease (motor symptoms in appropriately selected patients) • Subthalamic nucleus (STN)¹ ² ⁷ • Globus pallidus internus (GPi)¹ ² ⁷ • Primary dystonia (HDE, labeling varies by system and age group) • Globus pallidus internus (GPi)⁸ ⁹ • Subthalamic nucleus (STN)⁸ ⁹ • Drug-resistant focal epilepsy (adjunctive therapy) • Anterior nucleus of the thalamus (ANT)³ ¹⁰ • Obsessive-compulsive disorder, chronic severe treatment-resistant (HDE) • Anterior limb of the internal capsule (ALIC)⁴ ¹¹ Commonly treated off-label and/or investigational DBS targets reported in peer-reviewed literature (by condition) • Tourette syndrome (treatment-refractory cases in select centers) • Centromedian–parafascicular thalamic complex (CM-Pf)¹² • Centromedian nucleus–ventrooralis internus region (CM-Voi)¹² • Globus pallidus internus (GPi), anteromedial and posteroventrolateral subregions reported¹² • Anterior limb of the internal capsule (ALIC) and nucleus accumbens (NAc) reported in some series¹³ • Treatment-resistant depression and related mood disorders (investigational) • Subcallosal cingulate, also called subgenual cingulate (SCC, often referenced as area 25 region)¹⁴ ¹⁵ • Ventral capsule/ventral striatum (VC/VS)¹⁴ ¹⁵ • Nucleus accumbens (NAc)¹⁴ ¹⁵ • Medial forebrain bundle (MFB), including superolateral branch (slMFB)¹⁴ ¹⁶ • Chronic pain (selected cases, specialized centers, evidence varies by pain syndrome) • Periaqueductal gray (PAG) and periventricular gray (PVG)¹⁷ ¹⁸ • Sensory thalamus, commonly ventral posterior lateral (VPL) and ventral posterior medial (VPM)¹⁷ ¹⁸ • Anterior cingulate cortex (ACC), used in some approaches for pain suffering or affective pain components¹⁷ ¹⁸ • Ventral striatum/anterior limb of internal capsule (VS/ALIC) explored for emotional components in some work¹⁸ • Alzheimer’s disease and cognitive disorders (investigational) • Fornix¹⁹ • Nucleus basalis of Meynert (NBM)²⁰ • Obesity, binge eating, and appetite disorders (investigational) • Lateral hypothalamic area (LHA)²¹ • Ventromedial hypothalamus (VMH) and nucleus accumbens (NAc) appear as recurrent proposed targets in reviews²¹ • Anorexia nervosa and severe eating disorders (investigational) • Subcallosal cingulate (SCC)²² ²³ • Nucleus accumbens (NAc)²² • Bed nucleus of the stria terminalis (BNST) reported in case-based and trial literature²⁴ • Substance use disorders, including opioid use disorder (investigational) • Nucleus accumbens/ventral capsule region (NAc/VC)²⁵ ²⁶ • Chronic cluster headache (highly specialized, investigational in many regions) • Posterior hypothalamic region²⁷ ²⁸ • Ventral tegmental area or ventral tegmentum region discussed in connectivity and targeting work²⁸ • OCD beyond the FDA-HDE target (research and practice variation) • Ventral capsule/ventral striatum (VC/VS)²⁹ • Anteromedial subthalamic nucleus (amSTN)²⁹ • Inferior thalamic peduncle (ITP)³⁰ • Nucleus accumbens (NAc) and NAc-ALIC region approaches appear in target reviews and cohort work³¹ • Tremor targets commonly used as alternatives to VIM in some centers (especially essential tremor literature) • Posterior subthalamic area (PSA)³² • Zona incerta, commonly referenced clinically as caudal zona incerta (cZI)³³ ³⁴ Here is a master list of unique DBS target regions across currently approved, and commonly treated and/or studied conditions: • ACC, anterior cingulate cortex¹⁷ ¹⁸ • ALIC, anterior limb of the internal capsule⁴ ¹¹ • amSTN, anteromedial subthalamic nucleus²⁹ • ANT, anterior nucleus of the thalamus³ ¹⁰ • BNST, bed nucleus of the stria terminalis²⁴ • cZI, caudal zona incerta³³ ³⁴ • CM-Pf, centromedian–parafascicular thalamic complex¹² • CM-Voi, centromedian nucleus–ventrooralis internus region¹² • Fornix¹⁹ • GPi, globus pallidus internus¹ ² ⁸ • ITP, inferior thalamic peduncle³⁰ • LHA, lateral hypothalamic area²¹ • MFB, medial forebrain bundle (including slMFB)¹⁴ ¹⁶ • NAc, nucleus accumbens¹⁴ ²² ²⁵ • NBM, nucleus basalis of Meynert²⁰ • PAG, periaqueductal gray¹⁷ ¹⁸ • PSA, posterior subthalamic area³² • PVG, periventricular gray¹⁷ ¹⁸ • SCC, subcallosal cingulate (subgenual cingulate)¹⁴ ²² • STN, subthalamic nucleus¹ ² ⁸ • VC/VS, ventral capsule/ventral striatum¹⁴ ²⁹ • VIM, ventral intermediate nucleus of the thalamus¹ ⁶ • VPL, ventral posterior lateral thalamus¹⁷ ¹⁸ • VPM, ventral posterior medial thalamus¹⁷ ¹⁸ • VMH, ventromedial hypothalamus²¹ • Ventral tegmental area or ventral tegmentum region²⁸ • Posterior hypothalamic region²⁷ ²⁸

This section will address both the International and the United States FDA approved uses and non-approved therapeutic values of DBS as well as the conditions used to treat. It's important to know that regardless of approval, the paths to approval, and conditions to approve... insurance providers and countries with socialized medicine ultimately dictate every path and approval process. This process can take time and accurate documentation, which is where your medical team, and more importantly your medical team's billing department, can help the most to get the fastest approval. Get to know who this person is, because they can be your best friend... or not! What are the main FDA-approved DBS indications in the United States right now? In the United States, DBS has FDA-labeled uses for several conditions, depending on the device and the specific labeling. Key FDA-recognized indications include: • Tremor, including essential tremor and tremor as a primary symptom of Parkinson's disease, commonly treated with thalamic targets such as VIM.⁴ • Parkinson's disease motor symptoms in appropriately selected people, commonly treated with targets such as STN or GPi.⁴ • Dystonia, under the FDA Humanitarian Device Exemption pathway, for chronic, intractable primary dystonia, with labeling that can include pediatric ages depending on the approved system labeling.⁵ • Obsessive-compulsive disorder (OCD), under the FDA Humanitarian Device Exemption pathway, for chronic, severe, treatment-resistant OCD in adults, as an adjunct to medications and as an alternative to anterior capsulotomy.⁶ • Epilepsy, specifically bilateral stimulation of the anterior nucleus of the thalamus (ANT) as adjunctive therapy to reduce seizure frequency in adults with drug-resistant focal (partial-onset) seizures meeting labeling criteria.⁷ What does it mean if something is "HDE" instead of a standard FDA approval? The Humanitarian Device Exemption (HDE), is a US FDA pathway for devices intended for rare conditions. The labeling and evidence standards differ from standard premarket approval from the FDA, and the FDA materials for OCD and dystonia DBS explicitly note the humanitarian context.⁵,⁶ What movement disorder symptoms can DBS help most often, and what are the limits? DBS is best known for improving the symptoms of movement disorders. There are specifics by the FDA that carefully match the therapy to the right person, target, and programming plan, which we have alluded to: Every person is biologically unique!¹,⁴ For instance, in Parkinson's disease, DBS is used to manage motor symptoms and isn't a cure for Parkinson's disease or able to stop the disease progression.¹,⁴ In essential tremor, DBS aims to reduce tremor severity so daily tasks are easier, like feeding yourself and improving daily quality of life. DBS is not a guarantee to completely stop all tremors.⁴ Note: We just used the treatment of movement disorders in this example as it's a primary approved labeling in the United States. Please substitute the condition your are considering when learning about DBS! Can DBS help tremor related to Multiple Cclerosis (MS)? MS-related tremor has been studied with DBS as a therapeutic treatment with inconsistent results. Some people may benefit, but this has not been labeled by the FDA as an approved indication for treatment and is often discussed as a "complex tremor syndrome" where outcomes are less predictable than traditional movement disorders.⁸,⁹ If you have an MS tremor and DBS is being considered, you should ask your medical team what evidence applies to your specific tremor type, what the target area is for you, and what "success" would look like for you.⁸,⁹ Can DBS help treatment-resistant focal epilepsy, and what can it not promise? Yes, DBS in the anterior nucleus of the thalamus (ANT) is FDA-approved as helper therapy, "adjunctive" if you will, to help reduce seizure frequency in certain individuals with drug-resistant focal (partial-onset) seizures who meet the FDA's criteria.⁷ DBS can't promise seizure freedom and isn't to be considered as a replacement for antiseizure medications, but a treatment that works alongside traditional epilepsy medication treatment.⁷ As a patient or a care partner, long-term outcomes are going to vary, and care planning usually focuses on the best possible seizure reduction and safety.⁷ Can DBS help pain disorders? DBS for chronic pain disorders has had a long research history and is actively being studied, especially for refractory neuropathic pain syndromes. Some of these syndromes are as follows: • Post-Herpetic Neuralgia (PHN): Persistent nerve pain after shingles (herpes zoster) infection, often burning or stabbing. • Trigeminal Neuralgia (TN): Intense, electric shock-like facial pain in the distribution of the trigeminal nerve. • Diabetic Neuropathy: Nerve damage from diabetes, causing painful tingling or numbness, especially in the feet. • Complex Regional Pain Syndrome (CRPS): Chronic pain, swelling, and skin changes, often in an arm or leg, following injury. • Central Post-Stroke Pain (CPSP): Pain developing in the brain or spinal cord after a stroke. • Chemotherapy-Induced Peripheral Neuropathy (CIPN): Nerve damage from chemotherapy, causing numbness, tingling, and pain. • Failed Back Surgery Syndrome (FBSS): Persistent pain after spinal surgery, often due to nerve irritation. • Phantom Limb Pain: Pain felt in a limb that has been amputated. • Multiple Sclerosis (MS) Pain: Neuropathic pain from demyelination in MS. Other causes that may be treated are: • Compression (e.g., Carpal Tunnel, Sciatica). • Infections (e.g., Shingles). • Metabolic issues (e.g., Diabetes). • Trauma (e.g., Amputation, Injury). • Tumors or Spinal Stenosis. Research summaries that use specific and reproducible methods in order to find, appraise, and synthesize all of the available scientific evidence have described DBS targets such as the sensory thalamus and periaqueductal or periventricular gray for certain pain types, but results are mixed and depend heavily on pain diagnosis and target choice.¹⁰,¹¹ For most of the pain indications, DBS is considered "investigational" in the United States, meaning it's not labeled by the FDA for DBS treatment.¹⁰,¹¹ Can DBS help cluster headache and other severe headache disorders? DBS has been studied for medication-refractory chronic cluster headache, often targeting the posterior hypothalamic region. Many medical reviews and meta-analyses report that potential benefits may help some people, but this remains a specialized, higher-complexity area and also isn't labeled by the FDA for DBS treatment.¹²,¹³ If using DBS for cluster or severe headache disorders is on the table for treatment, it's reasonable to ask about the evidence for your headache subtype, any alternative neuromodulation options, and your medical team and the medical hospital system they work with's experience.¹²,¹³ Can DBS help addiction disorders? DBS for addiction disorders is actively being studied, including for substance use disorders such as alcohol and other drugs, but it is not FDA-approved in the United States for addiction. It is currently being used for individualized treatment in Canada with indication coming from your medical team. Recent research reviews show that the early clinical literature keeps this area of treatment as investigational.¹⁴ There is hope that it will be seen in studies as a viable source of therapy! What neuropsychological or psychiatric conditions have been treated with DBS, and what is the current status? DBS has been used and is still being studied in neuropsychiatric conditions. Currently, most of these uses are considered "investigational" in the United States, but outside of the continental United States, it is effectively being used for therapy. Examples commonly used and discussed in research and specialty centers include: • OCD, which has an FDA HDE-labeled indication in adults with chronic, severe, treatment-resistant OCD.⁶ • Tourette syndrome, which has ongoing clinical studies and specialty center use, but is not FDA-approved as a DBS indication.¹⁵,¹⁶ • Treatment-resistant depression (TRD), which is under active research. The FDA has also granted Breakthrough Device Designation for exploring DBS use in severe depression, which signals priority review potential but does not mean the indication is approved.¹⁷ • Other researched areas may include anorexia nervosa, post-traumatic stress disorder (PTSD), and other severe affective or behavioral disorders, typically within clinical trials and specialized settings.¹⁴,¹⁸ Are there any "new" DBS approvals happening right now that change what DBS can help? A recent major FDA development is adaptive DBS technology for Parkinson's disease, meaning a DBS feature that can adjust stimulation using sensed brain signals in the previously mentioned bi-phasic DBS system by Medtronic called the Percept series. This will definitely expand how DBS can be delivered for an already established indication, Parkinson's disease, rather than adding a brand-new condition indication.¹⁹,²⁰ It is currently being "turned on" for specific Parkinson's patients, and though it's thought of and marketed as a solution, there are patients with Parkinson's for whom it wasn't successful in treating. There is hope that manufacturers Boston Scientific and Abbott will be allowed to provide this type of possible therapy. This is one instance where "more cooks in the kitchen" will drive innovation to be more patient focused rather than the perceived race to be first, which is often expressed by patients with DBS. What conditions are "under current review for FDA approval," and how can potential patients know? Sadly, the public visibility into how the FDA review status works... varies. What is reliably visible are the publicly available FDA databases for approved treatment and the alternate pathways like HDE and PMA, and "Breakthrough Device Designation" announcements, which can often be hard to find.⁵–⁷,¹⁷ If someone is told a condition is "close to approval," the next practical step would be to ask: "Is this FDA-approved, HDE-authorized, or investigational for my specific diagnosis?"⁵–⁷ "If investigational, is it offered only in a clinical trial, and what protections and follow-up plans are in place?"¹⁸ "Which exact device labeling applies to me?"⁵–⁷ Does every DBS indication involve a multidisciplinary team that includes a neurosurgeon? Yes! DBS is a therapy that is implanted into the brain, so a neurosurgeon and his or her surgical team are the only way to get the electrode implanted and provide the perioperative care.¹–³ Beyond surgery, DBS is typically managed through a multidisciplinary team, and the mix shifts by indication: • Movement disorders DBS commonly involves a movement disorder neurologist, neurosurgeon, neuropsychology, nursing, and rehabilitation supports as needed.¹–⁴ • Epilepsy DBS commonly involves an epileptologist (seizure specialist neurologist), neurosurgeon, neuropsychology, imaging, and EEG team input, often through an epilepsy surgery conference process.⁷ • OCD and other neuropsychiatric DBS typically involves psychiatry, psychology, neurosurgery, and often research and ethics oversight, especially for investigational indications.⁶,¹⁸ • Pain and headache DBS, when pursued, may involve a pain specialist or headache specialist, neurosurgery, and careful psychiatric screening depending on the case.¹⁰–¹³ What is the medical team path to DBS approval, in plain language for me to understand? The path is different with each condition, medical team, insurance provider, and lastly health system. The common steps to get DBS in these situations can look like, but are not strictly adhered to this (Insurance will typically require a specific pathway, so check with your medical team's billing department for verification): Step 1: First medical contact: often primary care or an established specialist identifies that symptoms are not controlled well enough.¹–³ Step 2: Specialist referral: • Movement disorders: Primary care or general neurology, then a movement disorder neurologist.¹–⁴ • Epilepsy: Primary care or general neurology, then an epileptologist at a comprehensive epilepsy center.⁷ • OCD and Neuropsychiatric: Primary care or general psychiatry, then a specialty psychiatry team familiar with severe, treatment-resistant illness, often at an academic center.⁶,¹⁸ • Pain and Headache: Primary care or pain or headache specialist, then referral to a neuromodulation-capable center when appropriate.¹⁰–¹³ Step 3: DBS center evaluation: a team reviews diagnosis, symptom targets, treatment history, brain imaging, and overall health.¹–³ Step 4: Team conference and shared decision-making: many centers discuss candidacy in a multidisciplinary meeting to match goals, risks, and expected benefits.¹–³,⁷ Step 5: Surgery and follow-up care: DBS surgery is followed by DBS programming visits and ongoing monitoring.¹–³ What can DBS not promise, across all conditions? Across indications, DBS cannot promise: • A cure or a guarantee that symptoms will disappear.¹–³ • Stopping disease progression in neurodegenerative conditions.¹–³ • The same outcome for every person, even with expert surgery and follow-up.¹–³ • A one-time fix, since DBS typically requires ongoing programming and long-term care.¹–³

There is still so much unknown about how Deep Brain Stimulation (DBS) works even though we just looked at that earlier. Many like to indicate what is, and what is not . . . true. So in this section, let's look at some of these along with the sources, which can be found in the next FAQ section called "Sources." Why does DBS attract so much "fact vs fantasy" talk? Because DBS is real medicine, with research in the past and still being researched, each with real limits, it's the kind of therapy that can look dramatic from the outside. A short demonstration of DBS therapy may show a tremor easing, but it can't show the years and months of evaluation, the careful surgical procedure, and the constant fine programming and tuning that often follows.¹–³ Fantasy: "DBS is a cure. Fact: DBS is symptom treatment, not a cure. DBS does NOT cure the underlying condition. Many people may see symptoms ease up, but symptoms often don't go away completely.² DBS is also not successful for everyone, but it is for the majority.² Fantasy: "DBS stops disease progression." Fact: DBS treats symptoms; it does not stop progression. For certain conditions like Parkinson's disease, DBS is used for symptomatic relief in the later stages and helps manage certain medication-related problems, but it is not used as a disease-stopping therapy.⁴ DBS is a quality of life enhancer. Fantasy: "DBS is experimental for everyone." Fact: DBS includes FDA-approved uses and investigational uses. In the United States, some DBS uses are FDA-labeled for specific conditions, while others are investigational, meaning they are still being studied and are not FDA-labeled indications, even if ultimately they are proven by your medical team and approved by your insurance as a "last step therapy" after all other therapies have been exhausted. And more often than not, there has to be a record of current therapies not having been successful.²,⁵–⁷ Fantasy: "DBS is mind control." Fact: DBS is not intended to control identity, thoughts, or free will. DBS is designed to provide millivoltage stimulation to specific parts of your brain, "targets," in order to hopefully reduce the symptoms of your condition, disease, or disorder.¹–³ It's not designed to control a person's choices, but its effectiveness can be an aid in you making the best decision for yourself, along with the trusted consultation of your medical team. Still, the DBS stimulation can cause ripple effects, which were mentioned in another FAQ tab. This can, but not always, include mood changes, and those ripple effects need to be taken seriously and discussed with your medical team.² Fantasy: "DBS is the same as electroshock therapy." Fact: DBS and ECT are different treatments. Electroconvulsive therapy (ECT) is a noninvasive brain stimulation therapy that uses an electric current to induce seizure activity under anesthesia, and it is not an implanted device therapy like DBS, which is a neurostimulation system with programming being done over a period of time.⁹,¹–³ Fantasy: "DBS always means awake brain surgery." Fact: DBS can be done awake or under general anesthesia, depending on the plan. Many DBS lead placements are done with the person awake and alert so the effects of stimulation can be tested. Some neurosurgeons would rather do the placement while the patient is completely asleep; however, in some people, DBS lead placement is done under general anesthesia.² This is one of those places where the "right" approach depends on the condition, the medical team's preference, the surgical center's experience and capabilities, but ultimately it has to be what is safest for the individual.² Be sure to confirm with your neurosurgeon what they prefer to do, where they like to do surgery, whether it's awake or asleep surgery, and remember that if you are not satisfied with how your neurosurgery team does what they do, you have the right and personal responsibility to do what is best for YOUR care, even if that means postponing surgery to get a second opinion that aligns with your desires! Fantasy: "DBS works instantly for everyone." Fact: Programming and fine-tuning often take time. After your leads are inserted during surgery, the device is temporarily turned on, and the fine-tuning process of finding the best DBS settings for you begins.² This can be a mixture of them asking you during the awakened part of your surgery to do specific tasks, and during this time, as well as with full sleep surgeries, a sound bar is used to fine-tune using specific sound frequencies. Typically there is a "honeymoon" period where micro-lesions providing pressure around the electrodes reduce or remove the tremors for which you are being treated. This is typically where you as a patient are most elated! After a while, sometimes it's a week or more, the therapeutic value will fade away as you start to experience your symptoms again. At this time, you will go in for your first programming. Some initial settings may cause negative ripple effects, and this is where programming adjustments are often needed to find the best programming levels for you specifically.² This is also why DBS programming visits matter, so be sure not to miss any, and if you have to, notify your medical team to reschedule as soon as possible.²,³ Fantasy: "DBS replaces medication." Fact: DBS may reduce some medication needs, but it often does not replace medication. Many people will still need medications after DBS, depending on the condition DBS is used to therapeutically treat and your goals along with your medical team.² DBS is usually one strong tool inside a bigger treatment plan.²,⁴ In some conditions, part of your programming will be to do the programming without medication in your system and then an hour after your medication is taken to fine-tune the neurostimulation therapy in conjunction with your medication. Fantasy: "If it is implanted, nothing can be changed." Fact: DBS is adjustable, and that adjustability is a core advantage. DBS settings can be adjusted by your medical team over time, and some DBS systems allow limited changes that you can make that are clinician-approved at home with the DBS system controller via a smart device that connects via Bluetooth to your battery/generator.² Fantasy: "If DBS helps tremor, it must help every tremor." Fact: Tremors have different causes, and results depend on tremor type. DBS is commonly used for movement disorders, such as essential tremor and parkinsonian tremor, in the right setting.²,⁵ Some other tremor conditions, including more complex tremors, are studied and treated in specialized centers, but outcomes are typically less predictable.² This is a good question for your medical team, so ask: "What kind of tremor do I have, and what evidence fits that tremor type?"² Fantasy: "DBS is only for movement disorders." Fact: DBS is also used for epilepsy and some psychiatric conditions, and is actively being researched for other conditions. DBS is commonly approved for movement conditions and more easily diagnosed and approved than non-movement disorders.²,³ In the United States, as mentioned in another FAQ tab, DBS is also FDA-labeled for reducing seizures in hard-to-treat epilepsy in specific adults, and OCD has been approved with HDE authorization for severe, treatment-resistant cases in adults.²,⁶,⁷ Research continues in other areas such as depression, chronic pain, cluster headache, dementia, and addiction, which are generally discussed as investigational and have been implemented as a therapeutic treatment for these other areas on an as-necessary basis with approval by your medical team.²

What is and is not DBS Sources: (Note: I lost the links to the information but will provide soon!) 1. National Institute of Neurological Disorders and Stroke. Deep Brain Stimulation. National Institutes of Health. Accessed December 13, 2025. 2. Mayo Clinic. Deep brain stimulation. Accessed December 13, 2025. 3. American Association of Neurological Surgeons. Deep Brain Stimulation. Accessed December 13, 2025. 4. International Parkinson and Movement Disorder Society. Patient and caregiver education resources on DBS and movement disorders. Accessed December 13, 2025. 5. US Food and Drug Administration. Implanted neurostimulator device labeling and patient safety information, including MRI considerations. Accessed December 13, 2025. DBS Parts Sources: 1. National Institute of Neurological Disorders and Stroke. Deep Brain Stimulation (DBS). Updated August 1, 2025. Accessed December 14, 2025. h(https://www.ninds.nih.gov/health-information/disorders/deep-brain-stimulation-dbs?utm_source=chatgpt.com)ttps://www.ninds.nih.gov/health-information/disorders/deep-brain-stimulation-dbs (https://www.ninds.nih.gov/health-information/disorders/deep-brain-stimulation-dbs?utm_source=chatgpt.com) 2. American Association of Neurological Surgeons. Deep Brain Stimulation. Accessed December 14, 2025. h(https://www.aans.org/patients/conditions-treatments/deep-brain-stimulation/?utm_source=chatgpt.com)ttps://www.aans.org/patients/conditions-treatments/deep-brain-stimulation/ (https://www.aans.org/patients/conditions-treatments/deep-brain-stimulation/?utm_source=chatgpt.com) 3. Mayo Clinic. Deep brain stimulation. Updated September 19, 2023. Accessed December 14, 2025. h(https://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562?utm_source=chatgpt.com)ttps://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562 (https://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562?utm_source=chatgpt.com) 4. US Food and Drug Administration. Vercise PC, Vercise Gevia, and Vercise Genus Deep Brain Stimulation Systems (P150031/S064). Published June 18, 2024. Accessed December 14, 2025. h(https://www.fda.gov/medical-devices/recently-approved-devices/vercise-pc-vercise-gevia-and-vercise-genus-deep-brain-stimulation-systems-p150031s064?utm_source=chatgpt.com)ttps://www.fda.gov/medical-devices/recently-approved-devices/vercise-pc-vercise-gevia-and-vercise-genus-deep-brain-stimulation-systems-p150031s064 (https://www.fda.gov/medical-devices/recently-approved-devices/vercise-pc-vercise-gevia-and-vercise-genus-deep-brain-stimulation-systems-p150031s064?utm_source=chatgpt.com) 5. MedlinePlus. Deep brain stimulation. Updated December 31, 2023. Accessed December 14, 2025. h(https://medlineplus.gov/ency/article/007453.htm?utm_source=chatgpt.com)ttps://medlineplus.gov/ency/article/007453.htm (https://medlineplus.gov/ency/article/007453.htm?utm_source=chatgpt.com) 6. US Food and Drug Administration. Product Classification: Deep brain stimulation for the treatment of dystonia. Updated December 1, 2025. Accessed December 14, 2025. h(https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?id=SGS&utm_source=chatgpt.com)ttps://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?id=SGS (https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?id=SGS&utm_source=chatgpt.com) 7. Johns Hopkins Medicine. Deep Brain Stimulation. Accessed December 14, 2025. h(https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/deep-brain-stimulation?utm_source=chatgpt.com)ttps://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/deep-brain-stimulation (https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/deep-brain-stimulation?utm_source=chatgpt.com) 8. Massachusetts General Hospital. Deep Brain Stimulation (DBS). Accessed December 14, 2025. h(https://www.massgeneral.org/neurology/treatments-and-services/deep-brain-stimulation-dbs?utm_source=chatgpt.com)ttps://www.massgeneral.org/neurology/treatments-and-services/deep-brain-stimulation-dbs (https://www.massgeneral.org/neurology/treatments-and-services/deep-brain-stimulation-dbs?utm_source=chatgpt.com) 9. US Food and Drug Administration. Testing and Labeling Medical Devices for Safety in the Magnetic Resonance (MR) Environment. Published May 20, 2021. Accessed December 14, 2025. h(https://www.fda.gov/media/74201/download?utm_source=chatgpt.com)ttps://www.fda.gov/media/74201/download (https://www.fda.gov/media/74201/download?utm_source=chatgpt.com) 10. Medtronic. MRI Information: Deep Brain Stimulation Therapy. Accessed December 14, 2025. h(https://www.medtronic.com/en-us/healthcare-professionals/specialties/neurology/therapies-procedures/deep-brain-stimulation/mri-information.html?utm_source=chatgpt.com)ttps://www.medtronic.com/en-us/healthcare-professionals/specialties/neurology/therapies-procedures/deep-brain-stimulation/mri-information.html (https://www.medtronic.com/en-us/healthcare-professionals/specialties/neurology/therapies-procedures/deep-brain-stimulation/mri-information.html?utm_source=chatgpt.com) 11. Abbott Neuromodulation. MRI Scans with Your Neurostimulation Device (DBS). Accessed December 14, 2025. h(https://www.neuromodulation.abbott/us/en/support-parkinsons-tremor/mri-dbs.html?utm_source=chatgpt.com)ttps://www.neuromodulation.abbott/us/en/support-parkinsons-tremor/mri-dbs.html (https://www.neuromodulation.abbott/us/en/support-parkinsons-tremor/mri-dbs.html?utm_source=chatgpt.com) 12. Boston Scientific. ImageReady MRI Guidelines for Deep Brain Stimulation Systems. Accessed December 14, 2025.https://www.bostonscientific.com/imageready/en-US/dbs-system.html(https://www.bostonscientific.com/imageready/en-US/dbs-system.html?utm_source=chatgpt.com) How a DBS System Works Sources: 1. National Institute of Neurological Disorders and Stroke. Deep Brain Stimulation (DBS). Updated August 1, 2025. Accessed December 14, 2025. 2. Mayo Clinic. Deep brain stimulation. Updated September 19, 2023. Accessed December 14, 2025. 3. American Association of Neurological Surgeons. Deep Brain Stimulation. Published April 15, 2024. Accessed December 14, 2025. A(https://www.aans.org/patients/conditions-treatments/deep-brain-stimulation/)ANS+1 (https://www.aans.org/patients/conditions-treatments/deep-brain-stimulation/) 4. BrainFacts. Deep Brain Stimulation for Parkinson’s Disease. Accessed December 14, 2025. b(https://www.brainfacts.org/diseases-and-disorders/neurological-disorders-az/diseases-a-to-z-from-ninds/deep-brain-stimulation-for-parkinson-s-disease)rainfacts.org (https://www.brainfacts.org/diseases-and-disorders/neurological-disorders-az/diseases-a-to-z-from-ninds/deep-brain-stimulation-for-parkinson-s-disease) 5. Parkinson’s Foundation. Deep Brain Stimulation (DBS). Accessed December 14, 2025. P(https://www.parkinson.org/living-with-parkinsons/treatment/surgical-treatment-options/deep-brain-stimulation?utm_source=chatgpt.com)arkinson's Foundation (https://www.parkinson.org/living-with-parkinsons/treatment/surgical-treatment-options/deep-brain-stimulation?utm_source=chatgpt.com) 6. Chiken S, Nambu A. Mechanism of deep brain stimulation: inhibition, excitation, or disruption? Neuroscientist. 2016;22(3):313-322. Accessed December 14, 2025. P(https://pubmed.ncbi.nlm.nih.gov/25888630/?utm_source=chatgpt.com)ubMed (https://pubmed.ncbi.nlm.nih.gov/25888630/?utm_source=chatgpt.com) 7. Herrington TM, Cheng JJ, Eskandar EN. Mechanisms of deep brain stimulation. J Neurophysiol. 2016;115(1):19-38. Accessed December 14, 2025. P(https://pmc.ncbi.nlm.nih.gov/articles/PMC4760496/?utm_source=chatgpt.com)MC (https://pmc.ncbi.nlm.nih.gov/articles/PMC4760496/?utm_source=chatgpt.com) 8. Wang DD, de Hemptinne C, Miocinovic S, et al. Pallidal deep-brain stimulation disrupts pallidal beta oscillations and coherence with primary motor cortex in Parkinson’s disease. J Neurosci. 2018;38(19):4556-4568. Accessed December 14, 2025. P(https://pubmed.ncbi.nlm.nih.gov/29661966/?utm_source=chatgpt.com)ubMed+1 (https://pubmed.ncbi.nlm.nih.gov/29661966/?utm_source=chatgpt.com) 9. Mayo Clinic News Network. When to consider deep brain stimulation for essential tremor. Published November 7, 2023. Accessed December 14, 2025. M(https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-when-to-consider-deep-brain-stimulation-for-essential-tremor/?utm_source=chatgpt.com)ayo Clinic News Network (https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-when-to-consider-deep-brain-stimulation-for-essential-tremor/?utm_source=chatgpt.com) 10. Asadi A, Lancaster JL, Limousin P, Brown P. The origin of abnormal beta oscillations in the parkinsonian cortico-basal ganglia network. Neurobiol Dis. 2022;164:105615. Accessed December 14, 2025. P(https://pmc.ncbi.nlm.nih.gov/articles/PMC8896962/?utm_source=chatgpt.com)MC (https://pmc.ncbi.nlm.nih.gov/articles/PMC8896962/?utm_source=chatgpt.com) 11. Neumann WJ, Horn A, Ewert S, et al. Neurophysiological mechanisms of deep brain stimulation. Nat Rev Neurol. 2023. Accessed December 14, 2025. P(https://pubmed.ncbi.nlm.nih.gov/37450573/?utm_source=chatgpt.com)ubMed (https://pubmed.ncbi.nlm.nih.gov/37450573/?utm_source=chatgpt.com) 12. Medtronic. Medtronic earns U.S. FDA approval for the world’s first adaptive deep brain stimulation system for people with Parkinson’s. Published February 24, 2025. Accessed December 14, 2025. M(https://news.medtronic.com/2025-02-24-Medtronic-earns-U-S-FDA-approval-for-the-worlds-first-Adaptive-deep-brain-stimulation-system-for-people-with-Parkinsons?utm_source=chatgpt.com)edtronic News (https://news.medtronic.com/2025-02-24-Medtronic-earns-U-S-FDA-approval-for-the-worlds-first-Adaptive-deep-brain-stimulation-system-for-people-with-Parkinsons?utm_source=chatgpt.com) 13. University of California, San Francisco. New treatment can adjust Parkinson’s symptoms in real time. Published February 24, 2025. Accessed December 14, 2025.Home(https://www.ucsf.edu/news/2025/02/429506/new-treatment-can-adjust-parkinsons-symptoms-real-time?utm_source=chatgpt.com) DBS Target Sources 1. US Food and Drug Administration. Premarket Approval (PMA): P140009/S039. Accessed January 3, 2026. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P140009S039 (https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P140009S039&utm_source=chatgpt.com) FDA Access Data (https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P140009S039&utm_source=chatgpt.com) 2. US Food and Drug Administration. Premarket Approval (PMA): P960009/S478. Accessed January 3, 2026. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P960009S478 (https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P960009S478&utm_source=chatgpt.com) FDA Access Data (https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P960009S478&utm_source=chatgpt.com) 3. US Food and Drug Administration. Premarket Approval (PMA): P960009/S219. 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