Question 1

Who is Typically on Your Medical Team?

Accepted Answer

A DBS journey is not a single procedure, it is a longer path that moves from evaluation to surgery to programming and steady follow-up. But who helps you with this? That would be your own personal medical team that's a group of people with their own part to play. It's like they are all helping to carry a single lantern together with each person shining light on a different parts of your path, so you can see more clearly and make choices that fit your DBS goals and ultimately your quality of life. DBS care is often designed as a team where there is a continuum of care, because symptoms, mood, thinking, medications, and device settings can all interact.¹˒²˒³ Let's look deeper at each potential member, one by one!

First off, what is a DBS medical team? A DBS medical team is a multidisciplinary team, meaning multiple specialists coordinate care before, during, and after deep brain stimulation. It's this team approach that supports and helps decide the patient as a candidate, focuses on providing the safest surgery as possible, and providing long-term adjustment of stimulation and medications over time.¹˒²˒³
Which team members are most common, and what does each one do? Many medical centers include these roles, although the exact lineup varies.²˒⁴˒⁵ Let's look at them individually:
Movement Disorder Specialist (Neurologist)
 • Helps to confirm the diagnosis and symptom pattern, and clarifies which symptoms DBS is most likely to help.¹˒⁴
 • Guides shared decision-making by sharing benefits and limits into everyday expectations to you the patient.¹˒³˒⁴
 • Leads long-term care after surgery, including DBS programming and medication management, because stimulation and medications often need to be adjusted together.⁶˒⁷

Referring Physician if the Condition is Non-Traditional
 • This team member, if not for a movement disorder, is the physician who sends you to the functional neurosurgeon to investigate if you are a candidate for DBS therapy when all other therapies have failed. Conditions would include treatment-resistent depression, treatment-resistent focal epilepsy, and treatment-resistent pain or addiction concerns just to name a few.

Functional Neurosurgeon
 • This team member will explain the operation, the hardware, and the surgical plan, including what recovery usually looks like.²˒⁴
 • They will performs the actual DBS implantation procedure and manages surgical follow-up for healing and hardware concerns.²˒⁴
 • Lastely, they coordinate with neurology so the surgical outcome and programming plan match the goals discussed with you in evaluation.²˒³

Neuropsychologist
 • The neuropsychologist will perform neuropsychological testing which includes structured testing of memory, attention, problem-solving, language, and mood-related questionnaires.²˒⁴
 • They help the rest of your care team to understand your strengths and vulnerabilities that can affect recovery, coping, and day-to-day function after DBS.²˒⁸
 • This team member can also be involved in follow-up when thinking, behavior, or adjustment challenges show up after surgery.⁸
Psychiatrist or Behavioral Health Clinician
 • Sometimes this part of the team can be handled by the neuropsychologist, but this team member's specialty is screening and supporting of mood, anxiety, sleep, and impulse control concerns that can potentially influence your surgical readiness and long-term outcomes.²
 • They will also review any psychiatric medications you may be taking, or may be recommended to take, for safety and fit with your overall plan, especially when symptoms and stimulation settings are changing.²˒⁵

Clinician Programmer (DBS Programming Specialist)
 • The programmer adjusts your DBS programming settings to balance the symptom relief with any ripple effect you may experience. This is often done by a movement disorder specialist, your DBS rep, and in some centers also by trained advanced practice clinicians within the DBS program.⁶˒⁷
 • They also build a step-by-step plan for early programming visits, then ongoing follow-up visits as needs change over time.⁶
DBS Nurse, Nurse Practitioner, Physician Assistant, or Clinic Nurse Team
 • This team member provides education and practical coaching, including what to track at home and how to prepare for programming visits.⁵
 • They also help coordinate symptom logs, medication lists, and follow-up scheduling so care feels less scattered.⁵
Care Coordinator or Program Coordinator
 • The coordinator will organizes moving parts of your DBS plan, such as evaluation testing, visit scheduling, records gathering, and communication between specialties.⁵
 • They also provide for you the contact(s) information for which problem, so you're not guessing on who to call, and when.⁵

Rehabilitation Team: Physical Therapist, Occupational Therapist, and Speech Therapist
 • These team members support movement, balance, gait, strength, daily activities, voice, and swallowing when needed. DBS can help some symptoms, but many people still benefit from rehab support for function and safety.⁵
Anesthesiology Team (Surgery Day Role)
 • This team member is strictly there for the surgery procedure. They manage comfort and medical stability during the surgical process, and coordinates with the surgical team based on the planned approach.⁵
How do these team members work together across the DBS timeline? Most DBS programs follow a a path that includes: evaluation, surgery planning, implantation, then ongoing programming and follow-up visits.¹˒²˒⁴
 • Before surgery: The neurologist and neurosurgeon will evaluate fit, and many centers include neuropsychological testing and behavioral health review.²˒³˒⁴˒⁸
 • Surgery and early recovery: The neurosurgeon leads the implantation and immediate post-op care, while the rest of the team prepares for programming and longer-term support.²˒⁴
 • Post-surgery: These team members are focused on programming and medication management which often takes multiple visits, especially early on.⁶
Who is “the main point person” after DBS? In many DBS programs, the movement disorder specialist becomes the main clinical lead after DBS surgery because the ongoing outcomes can depend heavily on the stimulation programming and medication adjustments over time.⁷

Why does programming take more than one visit? DBS programming is not a single perfect setting that works forever, but is a focused process of adjusting stimulation settings, watching results, and refining. Many well-cited review describes that DBS programming will require multiple patient visits, often with more frequent follow-up early after surgery, then less frequent once settings are optimized.⁶

What can I do to make programming visits more effective? Please bring any information that helps your medical team see the bigger picture of your current health care, which can include:
 • A current medication list with doses and exact timing, including supplements.¹
 • A brief symptom log, what happens, when it happens, what makes it better or worse.⁶
 • Your top 3 life goals for DBS, stated plainly, like “walk to the mailbox without freezing” or “eat without shaking.”¹˒⁴
 • Notes about sleep, mood, and stress, because these can change symptoms and the way stimulation feels.²

What questions should I ask each member of the DBS medical team?

Questions for the movement disorder specialist, if not referred by a medical specialist:
 • Which symptoms are most likely to improve with DBS for my condition, and which are less likely?¹˒⁴
 • How will we measure progress, and what does “good enough” look like in real life?¹
 • Who will handle DBS programming, and how do medication management and programming work together here?⁶˒⁷
Questions for the functional neurosurgeon:
 • What is the surgical plan, and what does early recovery usually look like?²˒⁴
 • What are the specific warning signs after surgery that should trigger a same-day call?²

Questions for neuropsychology and behavioral health:
 • What did neuropsychological testing show as strengths and vulnerabilities?²˒⁸
 • If mood or impulse issues are a concern, what supports should be in place before and after DBS?²
Questions for the coordinator or nurse team:
 • What is the fastest way to reach the team for urgent device or symptom questions?⁵
 • What should I track at home between visits so we can adjust DBS programming efficiently?⁶

What if my DBS center does not have every specialist in-house? A DBS care team structure varies by medical center and by where you live.³˒⁵ If a team member role isn't available within your program, it may be handled through referral, shared care with local clinicians, or a separate clinic. If something feels missing, ask directly: “Who fills this role for your program, and how do we coordinate?”

Question 2

What are these "Pre-Surgical" Tests, and Why are they Necessary?

Accepted Answer

DBS pre-surgical testing is the set of visits and tests that happen before surgery to help your medical team decide whether DBS is a good fit and how to plan it safely. In this FAQ, we'll look at the most common parts of the pre-surgical workup in the United State (some of which are used Internationally as well), including specialist visits, brain imaging like MRI or CT, medical clearance and lab work, and testing that looks at memory, mood, and day-to-day function. You'll also see how testing can differ by condition, such as on and off medication exams for Parkinson’s disease and video EEG monitoring for epilepsy, plus practical questions you can bring to your appointments.

What is DBS pre-surgical testing? DBS pre-surgical testing is a set of visits and tests that help a DBS team decide whether DBS is a good fit, and how to plan the safest path forward. It's usually not just one test, but a coordinated evaluation that looks at your symptoms, overall health, brain imaging, and any thinking and mood factors that can help shape your recovery and long-term results.¹²³

Why do teams do so much testing before DBS? DBS is a mix of procedures and a long-term therapy. The pre-surgical evaluation helps your medical care team do the following:
 • Confirm the diagnosis and the symptoms DBS is most likely to help.³
 • Plan the surgical target using imaging like MRI or CT.¹²
 • Identify health factors that may change surgical planning, recovery support, or follow-up needs, through labs and medical clearance.²
 • Understand thinking and mood patterns that can affect day-to-day function after DBS, often through neuropsychological testing.⁴

What does a typical DBS pre-surgical evaluation include? Your exact workup depends on the condition you are being treated for and the medical center’s process, but many of the programs can include, but are not limited to:
 • Specialist visits with the DBS team, often neurology and neurosurgery.²³
 • Imaging, commonly MRI and or CT, used for surgical planning and accurate targeting.¹²
 • Blood and urine tests, plus medical clearance based on your health history.²
 • Neuropsychological testing to check memory, attention, problem-solving, and mood-related factors.⁴
 • Condition-specific testing, such as medication response testing for Parkinson’s, or video EEG monitoring for epilepsy.³⁵

What is the “on and off medication” exam, and who needs it? Some DBS medical centers and teams will evaluate symptoms when certain meds are and are not working, to see how the symptoms of your condition change. This is a more common practice in Parkinson’s disease evaluations, because response to Levodopa is often used as one predictor of how well some movement symptoms may respond after DBS.³ If your condition is not treated with levodopa, your team may use a different symptom scoring system or even different types of tests that are based on your condition and the goal of DBS.
What is “medical clearance,” and what might it involve? Medical clearance means checking that your body is ready for surgery and anesthesia, and that important health conditions are being managed. It often includes:
 • A review of your medical history and medications.²
 • Basic lab testing, such as blood and urine tests, which many DBS programs include before surgery.²
 • Additional evaluations if needed, based on your health, such as heart or lung assessment.²

What is neuropsychological testing, and why is it common before DBS? Neuropsychological testing is a structured testing of thinking skills, such as your attention span, memory, language, and problem-solving, and is often paired with mood and coping questionnaires. Many DBS medical centers and groups will require, or strongly recommend, this testing before surgery as part of candidate selection and risk planning.⁴ This testing isn't a “pass or fail.” Instead, it helps the your DBS medical team understand your strengths, your vulnerabilities, and support needs, so the plan they create and recommend for you will fit your real life.⁴

Will the evaluation include mental health screening? Often, yes. Many DBS medical teams will assess mood, anxiety, and other behavioral health factors because these can influence quality of life, recovery, and how someone experiences stimulation changes over time.⁴ The goal is strictly for clarity and support, not judgment of what you can and cannot do.

Why do I need MRI or CT imaging before DBS? Imaging helps the neurosurgical team map the brain and plan the target where leads should be placed. NINDS notes that noninvasive imaging, such as MRI or CT, is used before DBS surgery for targeting and planning.¹ AANS also describes MRI and or CT scans as part of the preoperative process.²
What if I cannot have an MRI? Some people can't have an MRI due to specific implants or other safety reasons. In those cases, teams may rely on CT-based planning or other tests, depending on the medical center's capabilities and your unique situation. NINDS describes both MRI and CT as imaging options used before DBS surgery.¹ If you find yourself a being questionable to not having imaging, ask this direct question to your medical team:

“If MRI isn't a safe option for me, what other imaging plans would you use, and how would that affect accuracy and safety for my DBS surgery?”

What does pre-surgical testing look like for Epilepsy DBS? If DBS is being considered for seizures, the evaluation may involve an epilepsy specialist and thorough testing to gain a better understanding of your specific seizure patterns. "The Epilepsy Foundation" describes tests that can include a 24 hour video EEG monitoring, MRI or other imaging tests, as well as cognitive neuropsychology testing, which may be done through an Epilepsy Monitoring Unit at a comprehensive epilepsy center.⁵

What about DBS being explored for depression, addiction, or chronic pain? In the United States, DBS is well-established for several movement disorders, and it also has an FDA-approved indication for certain adults with epilepsy. For depression, addiction, and some chronic pain uses, DBS may be offered mainly in specialized programs or research settings, depending on your location and the study or center. If your referral is for one of these areas, ask the team:
 • Is this care standard clinical care here, or research-based care?
 • What extra screening is required, and why?
 • Who will manage follow-up support if mood, sleep, or coping symptoms shift during treatment?⁴⁵

How long does DBS pre-surgical testing usually take? Timing will vary center by center, including availability, and how many specialty visits are needed for your specific DBS plan. Some programs complete testing over several visits, others bundle parts into longer clinic days. Because the processes can differ widely, it's a reasonable question to ask your coordinator for a “map” of the steps and typical timeline at your center.²³

How should I prepare for pre-surgical testing visits? These simple steps can help:
 • Bring a current medication list, including doses and timing, plus supplements.³
 • Bring prior imaging reports and relevant medical records if you have them.²
 • Write down your top goals for DBS in everyday language, and your biggest worries.³
 • Bring a support person if possible, because there is a lot of information to hold at once.²

What questions should I ask my DBS team about testing?
 • Which tests are required at this center for DBS candidacy, and which are optional?²³
 • What are you looking for in neuropsychological testing, and how will the results affect the plan?⁴
 • Will I need an on and off medication exam, and how should I prepare safely?³
 • What imaging will I need, and what happens if I cannot have MRI?¹²
 • After the workup, who explains the final recommendation, and what are the next steps?²³

Is this different outside the US? Yes, sometimes. Testing steps may be similar in spirit, but access, wait times, and which specialists are involved can differ by country and health system. Device options and program structure can also vary. If you are outside the US, ask your center which steps are required locally and how follow-up is coordinated.²³

Question 3

What is DBS Imaging and Brain Mapping, and What Does It Mean?

Accepted Answer

In this FAQ section, we will look at how brain imaging and planning are used in DBS care, and what “brain mapping” means in practical terms. We'll cover the common scan types you may hear about, such as MRI and CT, and how the imaging can be combined and reviewed for your target planning, as well as how your DBS medical team will decide on a best practice approach for navigation during the implantation portion of your surgery. We'll also look at other mapping tools that some medical centers may use, such as microelectrode recording, and how post-op imaging can be used to confirm lead location and support early programming decisions, along with clear questions you can bring to your appointments.

What does “DBS imaging and brain mapping” mean? DBS imaging and brain mapping refers to the "pictures and planning steps" that your DBS medical team will use to choose the safest path to your specific target where the electrodes will be placed accurately, and help confirm where the lead sits in your brain. This will typically involve MRI or CT scans before surgery, plus specialized planning software that helps the team map coordinates and plan the approach.¹˒² Typically during surgery the software will overlay the MRI and CT scans to get a greater glimpse that they are placing the leads in your exact target location.

Why does imaging matter so much in DBS? DBS will work best when the lead is placed in your specifically intended target area, and that stimulation is delivered to your correct brain circuit. The imaging will also provide your unique target localization, meaning that your medical team will be able to identify the exact spot and path your team has decided exact for your symptoms. Imaging also helps your team plan around your anatomy, including blood vessels and spaces that should be avoided.¹˒²
Which scans are most common before DBS? Many DBS medical teams and programs will use MRI, CT, or both. NINDS notes that before DBS surgery, a neurosurgeon uses non-invasive imaging, either MRI or CT scans, to help plan the procedure.¹ AANS also describes MRI and or CT as part of the preoperative process.²
What is the difference between MRI and CT for DBS planning? MRI (magnetic resonance imaging) uses magnets and radio waves to show detailed brain structures, while CT (computed tomography) uses X-rays and can be especially useful for showing bone and certain planning and confirmation steps and target locations. Some medical centers may combine information from both scans, depending on their workflow and your individual situation.¹˒²
What is “image fusion,” and why do some teams use it? As mentioned earlier, image fusion means combining two sets of images, such as MRI and CT, into one aligned view inside planning software. The goal is to use the strengths of each scan together. This is a common planning concept in modern DBS workflows, but the exact approach varies by center.¹˒²
What is “stereotactic planning,” in plain language? Stereotactic planning is a way to use brain images and a "coordinate system" to help your medical team plan the precise route to such a small brain target. This system can involve a head frame or a frameless system to prevent head movement, and is paired with software that helps your surgical team choose the right coordinates, angles, and depth for lead placement.²
What is the difference between frame-based and frameless DBS surgery? Both are methods of guiding accurate placement.
 • "Frame-based stereotaxy" uses a rigid frame attached to the head to create a stable reference for coordinates.
 • "Frameless systems" use other forms of registration, such as fiducials or surface mapping, to create that reference without a full frame.
Now, research that compared accuracy of both states that frame-based methods can have higher accuracy or precision in some settings, although clinical outcomes may still be similar in certain studies.³ Later research evaluated the targeting accuracy differences between bptj frame-based and frameless systems and provided a broader summary of this evidence.⁴ If your center offers both, ask how they choose between them for your condition and your anatomy.
What are “fiducials” or “markers,” and why might I hear those words? Fiducials are reference markers, typically drawn with a permenant marker on your scalp, that helps the navigation system match your physical head position to your scan images. They help the team align the real world with the brain images inside the planning software. Frameless workflows often rely on this kind of registration.⁴
Will I be asleep or awake, and how does that relate to brain mapping? Some DBS surgeries are done awake with testing, and some are done asleep using imaging-based targeting and confirmation. Both approaches are used in modern care, and are dependent on how your neurosurgeon prefers. If your surgery is done awake, that doesn't mean awake the full time, which is how they used to do the procedure. Typically they will put you to sleep then wake you for specific testing to determine that they have inserted the electrodes in the right location and depth.

What is microelectrode recording, and why do some teams use it? Microelectrode recording, which is often shortened to MER, is a technique that records your brain cell activity during surgery. It can provide physiologic feedback that may help refine lead placement in some workflows. If it is used, it usually includes a sound bar, like a bluetooth speaker you use at home, that emits frequency tones that indicate the right placement of your electrode(s). Whether MER is used depends on the center, the target, and your neurosurgeon’s and program’s approach.⁵˒⁶ A JNS article specifically appraises imaging-only approaches versus approaches that add MER guidance.⁶ It's reasonable to ask your DBS medical team the following questions:
 • Do you use MER for my target and condition?
 • If yes, what decision does it help you make?
 • If not, what imaging or confirmation steps do you use instead?⁵˒⁶

Do teams use brain “atlases” or maps that are not my personal scan? Some teams use atlases, also known as "standardized brain maps," to support planning and interpretation alongside your own MRI and CAT scan images. In a 2024 review it is described how a normative atlas can be applied in DBS surgery to support target localization and optimization, but this is one tool among many, and centers vary in how they use it.⁷
Will I have imaging after surgery too? Many DBS medical teams will do MRI and/or CAT scans post-op to confirm that the lead location is in the right target position, and to support lead localization in planning and programming. The exact timing and type of scan varies by your medical center and by the device and safety protocols. If your team does this, ask which scan they use and how it affects programming decisions.¹˒² Also remember to ask to get copies of ALL imaging before and after your surgery! You paid for it, and it's your right!

What questions should I ask my DBS team about imaging and mapping? Consider bringing questions with you to your visit:
 • Which scans will I have, MRI, CT, or both, and why?¹˒²
 • Do you use image fusion, and if so, what does it add for my case?¹˒²
 • Is your approach frame-based or frameless, and what are the pros and cons for me?³˒⁴
 • Do you use MER or test stimulation, and what decisions does it support?⁵˒⁶
 • Will you do post-op imaging to confirm lead placement, and how will it be used during programming?¹˒²

Is this different, or the same, outside the US? Often, these core tools are similar no matter where you live. MRI and CT with stereotactic planning included, but access to specific imaging technology, surgical workflows, and waiting times can vary by country and health system. If you are outside the United States, be sure to ask which scans are standard at your center and how imaging is scheduled and shared with your programming team.¹˒²

Question 4

What is the Difference in "Awake" and "Asleep" DBS Surgery?

Accepted Answer

This FAW will explain the two main ways DBS lead placement can be done. One where you are awake for part of the procedure, and the other, fully asleep under general anesthesia. We're going to look at what each option typically involves, why a DBS medical team may recommend one approach over the other, what tools may be used to guide the placement of the electrodes, and what research shows about outcomes of each method.

What does “awake DBS surgery” mean? "Awake DBS surgery" usually means that you're awake and able to respond for the part of surgery when the DBS leads are placed in the brain. Many medical centers and teams will numb the scalp with a local anesthesia, and some use sedation to help with comfort.¹⁻³ Typically you are asleep for the opening of your skull, which wasn't always the case, and then they wake you for the testing portion of the surgery. In awake workflows, teams may use real-time testing, such as microelectrode recording (MER) and test stimulation, to help confirm the target and check for side effects during lead placement.⁴⁻⁶
What does “asleep DBS surgery” mean? "Asleep DBS surgery" usually means that lead placement is done under general anesthesia, where you are asleep during that part of surgery.¹⁻³ Centers that offer asleep DBS surgery often rely on imaging-based targeting and confirmation, and some medical centers and teams may still use MER depending on their approach and equipment.⁴⁻⁶

Is one approach more “standard” than the other? Both approaches are used in modern DBS care. Historically, awake DBS was widely used, especially for movement disorders such as Essential Tremors and Parkinson's, because it supports real-time testing during lead placement.⁴⁻⁶ As imaging, navigation, and operating room systems have advanced, many centers have expanded asleep DBS surgery options, but practices will vary by DBS program, the neurosurgeon, and the technology that is available at the medical facility where the procedure is done.⁴⁻⁷

Why might a team recommend awake DBS? Some DBS medical teams may recommend awake DBS when real-time clinical feedback is important to their workflow, such as:
 • Testing how stimulation affects symptoms and side effects during surgery (test stimulation).⁴⁻⁶
 • Using MER to confirm brain signal patterns near the target.⁴⁻⁶
 Some centers also recommend awake DBS because it aligns with their long-term experience and established quality controls.⁴⁻⁶
Why might a team recommend asleep DBS? A team may alternatively recommend asleep DBS surgery when general anesthesia is expected to improve your comfort and tolerability, or when their imaging-based workflow supports accurate placement without needing you to be awake for testing.⁴⁻⁷ In a randomized clinical trial (for Parkinson’s disease with STN target), asleep surgery under general anesthesia had similar motor improvement and similar cognitive, mood, and behavioral adverse effects compared with awake surgery in that center’s workflow, and the asleep procedure was faster and described as less burdensome.⁵⁻⁶

What happens on surgery day in each approach? Exact steps vary by center, but common patterns include:

Awake approach, common elements
 • Scalp numbing with local anesthesia, sometimes with sedation.²⁻³
 • You may be asked to speak, move, read, or answer questions while the team checks effects during lead placement and stimulation testing.¹⁻⁴
 • The brain itself has no pain receptors, so discomfort is usually related to scalp, pressure, positioning, and operating room sensations.²⁻³
Asleep approach, common elements
 • General anesthesia for lead placement.²⁻³
 • Imaging-based targeting and confirmation may play a larger role during surgery, depending on the center’s tools and method.⁴⁻⁷

It's important to note that many DBS surgical procedures include more than one single stage. Some centers may use different anesthesia plans for different stages, such as implanting the battery device in the chest.¹⁻³
Will I feel pain if I am awake? This is information is purely educational, not a promise about any one person’s experience. You have to remember that your individual biology, tolerances, and mental health concerns may come into play in your being awake or asleep during DBS surgery. Most major medical sources state that if you're awake for lead placement, your typically asleep during the process of opening the scalp and skull, and the brain has no pain receptors, so it's safe to say that you shouldn't feel any pain.²⁻³ People may still notice pressure, vibration, or sounds during certain steps, and your DBS medical team should discuss strategies for your comfort ahead of surgery.²⁻³

What is MER, and is it only done when I am awake? MER (microelectrode recording) measures your brain electrical activity during surgery and can provide physiologic feedback to support target confirmation.⁴⁻⁶ It's often associated with awake DBS, but's not limited to awake procedures. In the DBS Surgery trials, frame-based MER-guided DBS was used in both study sections, including the general anesthesia section.⁵⁻⁶ This is why it's important to ask your DBS medical team whether MER is used, but how it is used at the medical center where your surgery is performed.⁴⁻⁶

What is “test stimulation,” and why does it matter? Test stimulation is a brief stimulation delivered during surgery to look for symptom improvement and is used to check for any ripple effects before finalizing your lead placement.⁴⁻⁶ It's a good thing! Awake DBS has traditionally supported this because you can respond and report sensations you feel, but each medical center workflows may  differ.⁴⁻⁶

Are outcomes different between awake and asleep DBS? Specifically for Parkinson’s disease, multiple evidence reviews, and a randomized trial, suggest that motor outcomes are often comparable between both the awake and asleep surgeries, while details can vary by medical center capabilities, condition targets, and method of surgery.⁵⁻⁷
 • A 2024 systematic review and meta-analysis (19 studies, 1,900 patients) reported no significant difference in common clinical outcomes between asleep and awake groups in pooled data, with differences noted mainly in operative time across studies.⁷
 • The 2021 GALAXY randomized clinical trial (110 patients) found equal improvement in motor function in both groups and similar cognitive, mood, and behavioral adverse effects in that center’s workflow.⁵⁻⁶
 • A 2024 Journal of Neurosurgery systematic review and meta-analysis also compared awake versus asleep DBS for Parkinson’s disease and summarizes outcomes and complications across published studies.⁸
 • A 2024 review in npj Parkinson’s Disease discusses how non-randomized studies often show comparable motor effects between approaches, while emphasizing differences in technique and center experience.⁹

The best question for your own understanding would be, “What does the medical center where I am having surgery, and my neurosurgeon, do well and often, and how success measured for my specific symptoms?”⁴⁻⁶

Are risks different between awake and asleep DBS? All DBS surgeries have the potential for risks, but DBS medical teams use careful testing, screening, and surgical protocols to reduce them.¹⁻³ Comparing awake and asleep DBS surgeries generally suggest that there is a similar overall effectiveness for Parkinson’s disease, specifically, while some studies report differences in specific adverse event patterns.⁶⁻⁹ Because these differences can depend on the surgical technique and your specific patient factors, ask your medical team what complications they track at the medical center where you will have DBS surgery, and what prevention and response plans they use.¹⁻³⁶⁻⁹

How do teams decide which approach is best for a specific person? Decisions are often based on:
 • Your diagnosis and the brain target being used.⁴⁻⁷
 • Whether your center relies on awake testing, MER, intraoperative imaging, or other confirmation steps.⁴⁻⁷
 • Your medical history and ability to tolerate being awake for part of surgery, including anxiety, “off medication” testing needs when applicable, and stamina.⁵⁻⁷
 • Your preferences after you understand what each day-of-surgery experience is like.⁵⁻⁷

Finally, what questions should I ask my DBS team? Here are some questions that can help you understand the plan that is presented for your surgery:
 • Which approach do you recommend for me, awake or asleep, and why?⁴⁻⁷
 • Will you use MER, and what decisions does it help you make during surgery?⁴⁻⁶
 • Will you use test stimulation, and what are you checking for?⁴⁻⁶
 • What imaging and navigation tools do you use for targeting and confirmation?⁴⁻⁷
 • What should I expect to feel and do on surgery day, including any speaking or movement tasks?¹⁻³
 • If part of surgery is awake, what comfort measures do you use, such as local anesthesia and sedation?²⁻³
 • How do you track outcomes after surgery, and how often are early programming visits?¹⁻³

What is the difference with the DBS surgery outside the US? Often the same two approaches exist internationally, but availability can differ based on health system resources, operating room imaging access, and how DBS programs are organized where you live.

Question 5

Can You Explain More about the Lead Placement and Targeting?

Accepted Answer

The topic of lead placement, and where the leads are placed, also known as the target, is an integral part of your DBS system's success. Your DBS medical team will choose your specific brain target and how the DBS lead will be placed in that location. In this FAQ we are going to look at what “targeting” means, the common brain targets used for different conditions.¹˒²˒³˒⁴
What does “targeting” mean in DBS? Targeting is the process of selecting the specific brain area where your electrodes/leads will be placed, then planning an accurate path so the DBS lead can be placed where stimulation is most likely to help symptoms while limiting side effects. DBS requires precise localization of the target using stereotactic, 3-dimensional imaging methods such as MRI or CT.¹˒⁴
What is a “target” in DBS? A DBS target is a small brain region that is part of your brain where the symptoms of your condition, disorder, or disease state is located. DBS surgery doesn't remove any of your brain tissue, instead it delivers electrical stimulation through contacts on the electrod lead directly to that target section where brain activity is influenced in your condition.³˒⁴

What is a DBS “lead,” and what part of the lead actually stimulates the brain? A DBS lead is a thin insulated wire that is placed in your brain, with small metal contacts that deliver the stimulation stimulation therapy directly into the area, or target, specific section. The lead connects, sometimes through an extension wire in your scalp, to a connector often placed behind your ear, down and over your collar bone and finally connects to your neurostimulator in your chest wall, typically in the right top of your chest.³˒⁵˒⁶

How does the team decide which brain target to use? Target choice is based on your diagnosis, the specific biology of your brain, the symptoms you most want to improve, and the balance between potential benefit and side effects for different targets. For instance, in the Parkinson’s Foundation information on brain target, the FDA has approved DBS targets that includes the STN, GPi, and VIM sections of the brain, and that target choice depends on symptoms and treatment goals.⁷ It's also been stated that DBS can be used for several movement disorders and epilepsy, and targets vary by condition.¹˒⁸ This highlights that different conditions where DBS is used as a therapeutic treatment can, and will have, different target ranges. Also if two people have DBS surgery for the same condition they can have the same target range, but be milimeters apart in location of the same target. It really boils down to your specific brain structure, which is determined in the imaging pre-surgery.
What are the most common targets, and what are they used for? Targets can vary by condition, center, and country, but a few common examples include:

Parkinson’s Disease
 • STN (subthalamic nucleus) and GPi (globus pallidus internus) are both widely used targets for Parkinson’s motor symptoms.⁸˒⁹
 • VIM (ventral intermediate nucleus of the thalamus) may be used when tremor is a main problem.⁷˒⁸

Essential Tremor
 • VIM is a commonly used target for tremor control.⁸

Dystonia
 • GPi is a commonly used target.¹

Epilepsy
 • For adults with drug-resistant focal seizures, the FDA-approved DBS target is the anterior nucleus of the thalamus (ANT), used as an adjunctive therapy to reduce seizure frequency in indicated patients.¹⁰

It's also important to know that DBS is also used in non-FDA approved conditions in the United States, as well as internationally, and is being studied for other symptoms and conditions in specialized centers, but target choice in those settings can be research-specific and not the same as FDA-approved uses.¹˒⁸

What is a “trajectory,” and why does it matter? A trajectory is the planned pathway the surgeon uses to place the lead from a small opening in your skull straight to your unique brain target. This planning aims to avoid blood vessels and other structures that increase risk, using imaging and stereotactic guidance.⁴ In some instance, such as with Medtronic, a robot will guide the electrode to the target, and even provides a video reference for the neurosurgery team to effectively navigate around important blood vessels to reduce stroke possibilities.
How is the lead physically placed during surgery? In most DBS procedures, the surgeon drills a small opening in the skull, then uses the stereotactic guidance, mentioned earlier, to place the lead along the planned path into the target. A Journal of American Medical Association patient page describes the drilling of the small skull opening and using stereotactic imaging guidance for electrode placement, and states that testing during surgery can be used to help confirm effective electrostimulation.⁴
Do all DBS surgeries use the same guidance method? No, as mentioned earlier. Some medical centers may vary in how they combine the diagnostic tools, and the approach can depend on the target, surgeon preference, and available technology. Some of the common options can include:
 • Imaging-based targeting, sometimes with intraoperative imaging confirmation.¹˒⁴˒¹¹
 • MER-guided targeting, sometimes combined with clinical testing or imaging.¹²
 • A hybrid approach that uses imaging plus MER or test stimulation.¹²

If two medical centers describe different workflows, that doesn't automatically mean that one is “better” than the other. It often means they are using different proven methods and quality checks.¹¹˒¹²

What is MER, and why do some centers use it? As addressed earlier, but it bears repeating, the MER (microelectrode recording) records your brain electrical activity during surgery using sound frequency tones that tell the surgery team that they are in the right place, or need to adjust as necessary. Some surgical teams will use MER to help confirm that the lead is passing through the intended target region, and to guide any small course corrections if it's necessary. A "J. Neurosurg" study showed that the imaging alone was sufficient for many patients, but also confirmed that many situations where MER-guided adjustments helped correct suboptimal targeting.¹²
What is “test stimulation,” and what does it tell the team? "Test stimulation" is a brief stimulation delivered during surgery in some workflows. It can help the team look for symptom improvement and check for side effects before finalizing lead position. A major clinical description notes that testing during surgery may be done to help ensure the electrode will stimulate the intended neurons that reduce symptoms.⁴ Often during your awake surgery, if your team decides that the best course for your DBS surgery, you may be asked when awake, if you feel a sensation that would be similar to your hands falling asleep. They will then ask you to let them know when it's "too much" at which time they will back that stimulation down just a bit. This enables your DBS medical team to have a "top end" of electrostimulation that they can't exceed when programming.
How do surgeons confirm the lead is in the right place? The confirmation methods of your lead placement may vary by medical center and could include the following:
 • Intraoperative imaging, such as CT in the operating room, to confirm lead position.¹¹
 • Postoperative imaging, such as CT or MRI, used to confirm lead location and support later programming decisions.¹³
One study described the use of intraoperative CT with a skull-mounted (halo style of head stabilizing) stereotactic system to place DBS electrodes and evaluate the accuracy of the lead placement.¹¹
What is “lead localization,” and why might my team talk about it after surgery? The lead localization means that your surgical team will identify exactly where your leads and contacts sit relative to the intended target based on imaging. This helps the programming team understand which of the four contacts on your leads are most likely to help your symptoms and how give them a best practic on adjusting settings over time. Research and clinical workflows commonly use postoperative CT or MRI to support electrode reconstruction and localization.¹³
Does a small change in lead position really matter? YES!!!! (Did I say yes?) Yes! DBS targets are small, and stimulation can spread to nearby structures depending on settings and contact location. This is one reason many teams use multiple confirmation steps, and why programming may involve careful adjustment over time.⁷˒¹²˒¹³ When dealing with location of the electrodes in your specific target, one milimeter off can make a world of difference! 
Are there different types of leads that affect targeting? Most DBS leads have multiple contacts, with the standard being four contact per lead, so stimulation can be delivered at different levels along the lead at any one of four ports. Some newer leads are “segmented” or “directional,” meaning stimulation can be shaped more to one side, which helps to reduce certain ripple effects for some people, depending your specific anatomy and unique programming. The Mayo Clinic has described segmented leads as a tool that can allow more precise stimulation.¹⁴ Now, this doesn't change the main goal of your targeting, which is still accurate placement in the right region, with programming choices layered on top.¹³˒¹⁴
What questions should I ask my neurosurgeon or DBS team about targeting? These questions can help you understand the plan clearly:
 • What target are you recommending for my symptoms, and why that target instead of another option?⁷˒⁸˒⁹
 • What imaging will you use for planning, MRI, CT, or both?¹˒⁴
 • Do you use MER, test stimulation, or intraoperative imaging to confirm placement? What does each step add at your center?¹¹˒¹²
 • How do you check lead location after surgery, and will that information be used during programming?¹³
 • If symptoms or side effects show up later, how often do you see that related to programming versus lead location? What is the usual next step?¹²˒¹³

How does this differ if you are not in the United States? Most of the core concepts are similar worldwide, but availability of specific imaging systems, such as MER, and intraoperative imaging, can vary by country and by hospital resources where you live. Also, certain approved indications and medical payment pathways may differ, which can affect which targets and devices are commonly used in routine care.¹˒¹⁰

Question 6

What can you Share about Anesthesia and Pain Control During and After Surgery?

Accepted Answer

DBS surgery can sound intense until you understand the comfort plan that is set for you by your medical team. This FAQ will explain DBS anesthesia and pain control in easy to understand language, what typical pain is versus pain that may be concerning, and how to talk with your team so there are fewer surprises. The goal is to remove the veil, so you can see the steps for your surgery clearly, and walk into the process with steadier footing and more light.

What does “anesthesia” mean in DBS surgery? Anesthesia is the medicines and techniques that reduce pain, anxiety, and awareness during surgery. In DBS, anesthesia choices can range from local anesthesia (numbing the scalp) with light sedation, to general anesthesia (fully asleep with a breathing tube), and depending on the medical center and your medical team, the surgical plan, and your health needs.¹
Will I be awake or asleep during DBS lead placement? As mentioned earlier, it really depends on the approach your medical team and medical center uses. Many DBS programs offer both the awake and asleep DBS surgical options. Both approaches are used in modern DBS surgery and care and your medical team will recommend what best fits your specific situation and their tools.¹
Why would a team choose awake DBS? Awake DBS has been used for decades, and a common reason could be that your medical team can confirm the target in real time using microelectrode recording (MER), which listens to brain-cell firing patterns, and may also do test stimulation to check symptom change and watch for side effects during surgery.²,¹⁰ Some people also like knowing they can communicate during parts of the procedure. Others do not, and that is valid too.
Why would a team choose asleep DBS? Asleep DBS can improve comfort for people who don't want to be awake, who may struggle with lying still because of their specific condition and temors, or who have anxiety or other factors that make an awake procedure harder.²,¹ (On a side note, when you are in pre-op you can request medication in your IV to help you with your nerves. Let's just say that Verset is an amazing drug!) In asleep DBS, teams often rely more heavily on imaging guidance, sometimes with intraoperative CT or MRI, and some centers still use MER even under general anesthesia.¹¹,³
Does awake vs asleep DBS change results? As mentioned previously, DBS outcomes are often similar between awake and asleep DBS for Parkinson’s disease, when performed by experienced teams.²,³,⁶ With that said, every method has tradeoffs, and research does not always match every individual’s experience.

What is “sedation,” and what does it feel like? Sedation means that medication is applied, typically via IV, that helps you feel calm, sleepy, and less aware of time passing. Sedation can be light (relaxed but awake) or deeper (very sleepy). In DBS, sedation is often adjusted so it doesn't interfere with the surgical plan, especially if MER or testing is planned.¹,¹⁰ If you're worried about discomfort, it helps to let your pre-surgical team know as soon as possible! Your anesthesia team is there to help you feel safe and steady, not to judge you.
Will I feel pain during DBS surgery? DBS surgery is designed to prevent pain as much as possible. Local anesthesia is used to numb the scalp for awake procedures, and general anesthesia prevents awareness during asleep procedures.¹,² It is still possible to feel pressure, vibration, or stiffness of you are not asleep during the burring of the holes in your skull, from positioning, and some people may feel discomfort during certain moments, which is not typical. Your team can explain what sensations are most common at their center, and what they do to reduce them.¹

What pain is common after DBS surgery? You may have some temporary soreness, swelling, or tenderness at incision sites, such as the scalp and the chest where the pulse generator sits.⁷,⁶,⁸ Post-surgerical headaches can also occur after DBS surgery, and temporary pain and swelling at implantation sites are recognized post-surgery effects.⁶,⁸ Often over the counter pain medication is optimal, but if you need more ask your medical team for advanced pain control medications. If your pain feels suddenly severe, keeps escalating, or comes with new neurologic symptoms (like new weakness, confusion, or trouble speaking), treat that as urgent and contact your medical team right away, or seek emergency care if severe.⁶,⁸
How is pain usually controlled after DBS surgery? Pain control varies by person and by surgeon, but many neurosurgery programs use a stepwise plan: start with simpler options, then use stronger medicine only if needed. After brain surgery, acetaminophen (Tylenol) is commonly used, and opioids may be reserved for more severe pain.⁹ It's important to know that your DBS medical team will tell you exactly what you can and can't take and when. Different medical teams and centers restrict NSAIDs (like ibuprofen or naproxen) for a period after surgery because of bleeding-risk concerns and their own protocols.⁹
What side effects can come from anesthesia or stronger pain medicines? Some of the possible side effects can depend on the medications that are used. For instance, nausea, sleepiness, constipation, and confusion, can be rough especially with opioid pain medicines.⁹ Anesthesia and sedation also carry general risks, which can include, rare but serious complications. Your anesthesia team will review these with you based on your specific health history.⁸ If you do have a history of nausea with anesthesia, motion sickness, or constipation with pain medicines, tell your anesthesia team before surgery, so they can plan ahead.

What can I do, non-medication, to make recovery pain easier? The following recommendations can provide some comfort while your body heals:
 • Rest in short cycles, then do some gentle movement like brief walks if your surgeon allows.¹⁰
 • Use positioning to reduce swelling, such as keeping your head slightly elevated, if recommended by your surgical team.⁹
 • Protect your sleep! A quiet, dim room can help your nervous system settle.
 • Be sure to ask about incision care rules, and follow them closely, because irritated skin and tight healing tissue can worsen tenderness.⁸
Always follow your neurosurgeon’s specific restrictions and wound-care instructions, which typically is shared with your care partners while you are in recover.

When should I call my DBS team, and when is it an emergency? This is an important question, because you are already in a place, post-surgical, where you are feeling all new sensations - good and bad. If you have questions, call your DBS medical team immediately if you notice any signs of infection or wound problems, such as fever, drainage, increased redness or swelling around incisions, or new numbness, weakness, or tingling.⁸ If symptoms feel urgent or severe, such as new seizure, loss of consciousness, sudden severe weakness, trouble breathing, or signs of stroke, seek emergency care immediately.⁶,⁹
What are some questions that I should ask my DBS team about anesthesia and pain control?
Bring these questions to your pre-op visit with your DBS team or medical center:
 • Will my DBS lead placement be awake DBS or asleep DBS, and why?¹,²
 • Will you use MER or test stimulation during surgery? If yes, how does that affect sedation?¹,²
 • What should I expect to feel: pressure, noise, vibration, or pain? What is “normal” at your center?¹
 • What is your plan for nausea prevention and constipation prevention if opioids are needed?⁹
 • What pain medicines are allowed after surgery, and which are restricted, and for how long?⁹
 • What symptoms mean: call the clinic today, call after hours, or go to the ER now?⁸,⁹
 • If I have anxiety, claustrophobia, trauma history, or trouble lying still, what comfort options do you offer?¹

Now, many DBS surgical techniques, anesthesia practices, and device availability can differ by where you live, and even between hospitals in the same geographical region. If you live outside the United States, ask your DBS medical team and medical center what is standard in your local system and what options are realistically available.¹

Question 7

What does Hospital Discharge and Planning Look Like?

Accepted Answer

Hospital and discharge planning is often something that isn't discussed with your medical team when talking about your DBS surgery. It can feel overwhelming, where questions often get forgotten. This FAQ helps you understand some of the questions to ask, and address concerns you may not have realized. In this FAQ we hope to share what a typical DBS hospital stay could look like, what “ready for discharge” usually means, what to plan for at home, and which questions help you leave the hospital feeling clearer, steadier, and supported. Understand that each medical team and medical center will have different answers for each patient and geographical location, so please understand these are general indications that hopefully will help you have a better understanding of possibilities.

What does “DBS hospital and discharge planning” mean? DBS hospital and discharge planning is the phrase that indicates the preparation for what happens right after surgery, how your medical team may check your recovery in the hospital, and how you transition home with a clear plan. It can include pain control, mobility and safety checks, wound care instructions, a medication plan, and follow-up scheduling for device activation and programming.¹,²
How long is the hospital stay after DBS surgery? Hospital stay length varies by medical center and by how you recover. Some programs describe a stay of about 24 hours, while others note one to two days is common.¹,⁶ If your plan includes more than one stage of surgery, the length of stay can differ by stage and by your individual needs.⁴,⁶
Will I go to the ICU after DBS surgery? Some medical centers observe patients in an ICU unitt overnight, especially after lead placement, while other medical centers use a "step-down" unit or standard neurosurgery floor. It all depends on your hospital's protocols and your specific health needs.⁴ Ask where will you recover the first night, and why?
What usually happens in the hospital after DBS lead placement? While medical rounds routines cam vary, many hospitals focus on the following basics as part of their post-surgical protocol:
 • Monitoring: frequent checks of alertness, speech, strength, and comfort.¹
 • Imaging: some centers confirm lead position with a scan, depending on their workflow.²
 • Mobility and safety: many programs involve physical therapy or mobility checks before discharge.⁴

Your medical team will tell you what post-surgical tests they do and what “normal recovery” looks like in their hospital. Typically, you will have some form of imaging (MRI or CAT Scan) to confirm that the lead placement is correct, and as always, ask for a copy of your imaging, and the report, before you leave to go home!

Question 8

How can I Prevent Infection Prevention Pre and Post DBS Surgery?

Accepted Answer

The goal to prevent any infection around your DBS surgery isn't about the ability to have a perfect spotless system in place, but more about having a clear plan in place with the primary focus of this FAQ is to better explain what infection, and their implications, can mean in your DBS surgery process. It's also about what steps your hospital team handles automatically, and what steps you can control at home before and after surgery. The goal is that with fewer surprises, earlier recognition of potential problems, and a smoother recovery, confusion can be put to rest . . . so you can rest!

What kind of infection are we talking about with DBS? Most infections related to DBS are surgical site infections (SSIs), meaning infections that are in, or near, the incision area after surgery. In DBS surgery, this can involve your scalp incision, the chest incision where your battery is placed, or the path where the extension wire runs under the skin.¹,²,³ Since DBS is an implanted system, infection can sometimes involve the hardware and not skin. That's one reason why DBS infections can be harder to treat than a simple surface wound.¹,²
How common are DBS infections, and when do they usually happen? Reported DBS infection rates are found to vary across multiple studies and reports from medical centers, partly because the patient populations and the surgical methods can, and often, differ. Published studies commonly report that the infection rates typically run the single digits, with those infections often appearing in the first few months after surgery.¹,² When you drill down into the study it shows that over half of the infections occurred within the first month, and most occurred within the first three months.² This is interesting when typically most of the infections are indicated that they start in the surgical process, which would be detectible well before the first month's end. Another study from the Mayo Clinic noted that DBS device infections typically occur within a few months after placement or revision.³
If your medical team, and medical center, tell you a different recurrence for their specific surgical program, then that's worth listening to, because local infection rates depend heavily on local practices and patient mix.⁴
What causes DBS infections, and what germs are most common? Many DBS infections are caused by bacteria that normally live on the skin, especially Staphylococcus species.³ This is why skin prep, incision care, and early monitoring matter so much.⁵,⁶

What increases infection risk in DBS surgery? Risk factors always vary study by study, as well as by one medical center to the next, but research on DBS hardware infections has really identified specific patterns, such as higher infection risk after revision procedures, and some factors are directly related to how the wounds heal and the patient's skin tissue integrity.¹,³,⁷ Another known risk is skin erosion, which means the skin is thinning, or breaks down, over the implanted parts such as the battery, which can open a pathway for bacteria. Most DBS device manufacturers warn that manipulating or pressing on implanted components can contribute to skin erosion and may increase infection risk, however if you ask anyone with a DBS system . . . it's just plain cool to feel the battery under the skin!⁸,⁹ Be sure to ask your medical team, "Based on what you know about my health history and my planned device, what would make infection more likely for me, and what are we doing to lower that risk?”¹,³
What can I do before DBS surgery to prevent infection? Try to think of pre-surgery prevention as lowering the “germ load” on your skin and lowering avoidable irritation to skin. Most steps are simple, but they need to match your hospital’s instructions. Most medical centers, during the pre-admin before surgery will provide anti-bacterial soap and showering instructions before you show up for your surgery. With that said, let's look at some other practical steps you can ask your medical team about:
 • Showering or bathing: It's often advises that patients to shower or bathe using soap either the day before or the day of surgery.¹⁰ (See the previous mention of this!)
 • Special antiseptic washes: Some hospitals instruct patients to use chlorhexidine (CHG) soap. Evidence summaries from WHO note that CHG bathing has not consistently shown benefit over plain soap for reducing SSI rates, so practice varies.¹¹,¹²
 • Hair removal: If your surgical team states that hair removal is needed in your specific case, they will say that they generally discourage shaving with a razor because it can irritate skin and raise infection risk. Hair removal, if done, is typically done by the surgical team using safer methods.¹³
 • Tell your team about any current infections: DBS Device makers caution against implantation where there is an active general infection, and surgical teams will often postpone the elective implants part of your surgery if there is an untreated infection elsewhere.⁸

It's helpful to remember to follow your medical team and the medical center’s written instructions exactly, even if a friend’s hospital did something different. Infection prevention is equal parts science and your local hospital system.
What infection-prevention steps does the hospital do during surgery? Hospitals typically use a “bundle” of steps aimed at reducing SSIs, which can include the following steps:
 • Antibiotic prophylaxis: giving antibiotics around the time of surgery to reduce infection risk, following local protocols and evidence-based guidance.¹²,¹⁴
 • Operating room skin antisepsis: cleaning the surgical area using antiseptic solutions as part of standard SSI prevention practices.¹²,¹⁴
 • Sterile technique and careful handling of implanted hardware: standard surgical practice designed to reduce contamination.¹²

You don't need to memorize every technical detail that is provided for you pre and post DBS surgery, but the primary condideration for you would be to ask your medical team what your DBS infection-prevention routine looks like, and what does your team do differently for implants compared to non-implant surgeries and get that written down or printed out so you can have it readily available to refer to, and most DBS medical teams do this by default. It helps you, and covers liability on their end.¹,⁷,¹²

What should I do right after surgery to lower infection risk? Most post-op prevention is about protecting healing skin and reducing accidental contamination. Commonly it's considered to have a best practice infection prevention plan provided by your hospital system, which is a list of "do's" and "don'ts" of your discharge paperwork before you go home:
 • Keep the wound dry for a period: Some DBS discharge instructions advise keeping your wounds dry for a few days, then gently washing with soap and water, and not submerging in water.¹⁵
 • Avoid soaking: Many DBS instructions advise against taking baths, and being in pools or hot tubs until you are cleared by your medical team in that first post-surgical followup visit, because soaking can increase contamination risk while incisions seal.¹⁵,¹⁶
 • Avoid picking, rubbing, or pressing on the device sites: DBS manufacturers warn that pressure or manipulation can contribute to skin breakdown and possible infection risk. So, leave the wounds alone, especially during the healing process when there may be a little bit of itchiness.⁸,⁹

• Follow dressing instructions exactly: If you have medical dressing on your surgical wounds (and you will!), be sure to follow the timeline your medical team gives for removal and cleaning.¹⁶
Because individual medical center protocols will vary, what another one center does, may not be what your medical center tells you to do.¹⁶
Should I put antibiotic ointment, creams, or powders on my DBS incisions? No! Don't apply ointments, solutions, or powders unless your surgical team specifically tells you to. Some SSI prevention guidance advises against routinely applying topical antimicrobial agents to surgical incisions, because the routine use hasn't consistently shown to be of benefit and can potentially irritate your skin and complicate wound assessment.¹⁴

What are early warning signs of infection after DBS? Some warning signs can include increasing redness, swelling, warmth, drainage, wound opening, fever, or worsening pain after an initial period of improvement. Your DBS care team should provide some education resources that will have all of those symptoms and state that any worsening swelling or inflammation at surgery sites may signal infection.¹⁷ It's normal to have some tenderness, mild swelling, and bruising early on. Healing usually trends toward less pain and less redness over time, and not more.¹⁶,¹⁷

What is “device erosion,” and why does it matter for infection prevention? Device erosion is where your skin may thin, or break down, over your generatory, or the top caps in your skull that keeps your electrodes in place. It may even apply to where the connector is, typically behind your ear as well as the extension wires that go from this connector to your battery. Broken skin can become an open door for bacteria to reach your implanted hardware. DBS manufacturers also warn that rubbing or pressure on implanted components can contribute to skin erosion and may lead to infection or the need for additional surgery.⁸,⁹ (We addressed this previously . . . it's just so hard to not touch something inside of your skin!) Now, if you notice your skin is thinning or a scab that won't heal, if your visible hardware outline is getting more defined and easier to see, or if any area that looks like it is trying to “push through,” call your DBS team immediatly!⁸,⁹

What happens if a DBS infection is suspected? Your medical team will evaluate your wound, the symptoms, and sometimes order tests such as wound cultures or imaging, depending on the situation. DBS device infections are often managed with antibiotics, and sometimes they may require surgical procedures, especially if hardware is involved.³,¹⁸ Because your specific management decisions will depend on the severity, location, and whether your hardware is involved, this is a “call your team early” situation, not a “wait and see for a week” situation.³,¹⁸
What questions should I ask my DBS team to build a clear prevention plan? Before surgery, be sure to ask the following questions to your medical team:
 • Do you want plain soap showers, CHG showers, or something else? When do I start?¹⁰,¹¹
 • Should I avoid shaving my scalp or chest area, and will your team do hair removal if needed?¹³
 • If I have a dental issue, skin rash, urinary symptoms, or another possible infection, what should I do before surgery?⁸

After surgery, ask the following questions as well:
 • How long do I keep incisions dry, and when can I shower?¹⁵,¹⁶
 • When can I submerge in water, like baths, pools, or lakes?¹⁵
 • What exact signs mean “call today,” and what signs mean “go to the ER now”?¹⁶,¹⁷
 • If a wound looks irritated, should I cover it, uncover it, or send a photo to the clinic?¹⁶

Now, if your concerns or symptoms are urgent or severe, we will always recommend you seek emergency care immediately. Examples include rapid worsening confusion, seizure, severe headache with new neurologic symptoms, trouble breathing, chest pain, or any rapidly worsening condition.¹⁹

Lastly, infection-prevention routines may vary from country to country and by hospital systems where you are, including which antiseptic washes are used, how long incisions must stay dry, and how follow-up is handled. The World Health Organization's guidance is widely referenced internationally, but your surgical team’s protocol is the one you should follow day to day.¹⁰,¹¹,¹²

Question 9

How can I Prepare my Home for My Recovery?

Accepted Answer

Preparing your home for DBS recovery is totally about your safety, comfort, and just plain making it easier for you to better follow the discharge instructions that you will be given before you leave the hospital. In this FAQ we want to look at pre-surgical things to do, and what you may want to handle during the first couple of weeks at home. We also want to help you prepare for how to plan for follow-up visits and programming, along with which symptoms should lead you to call your care team.
Why should I prepare my home before DBS recovery? After DBS, it's common to have fatigue from the anesthesia and procedure, some potential soreness at your incision sites, and some basic, and temporary, limits on lifting and activity. We want to offer some ideas for you to consider when preparing your home to reduce falls and make daily tasks easier while you heal.¹,²

When should I start preparing my home? If possible, starting to prep your home before surgery, even a few days, will help so much. It can remove worry of "what have I not thought about" when you are on the way home from the hospital. Many DBS teams will keep you for a short hospital stay after lead placement, typically one night, and a faster discharge after the pulse generator procedure, sometimes same day, so home readiness matters early.⁴,⁵,⁶
Do I need someone with me when I get home? Many DBS discharge instructions will require someone to drive you home after your outpatient DBS surgery and even recommend someone stay with you overnight, especially after the generator is installed.⁷ This is also a really good idea for the first 24 to 48 hours because anesthesia, pain medicine, and fatigue can make balance and memory worse temporarily.⁷,⁸

What is the biggest home safety priority right after DBS? Fall prevention, hands down! Some DBS information will warn that there may be temporary balance or speech changes that can happen after your lead placement, and your medical team may recommend extra caution on stairs and while walking.⁷ Let's look at some simple fall prevention considerations:
 • Clear pathways, remove clutter and cords.
 • Remove loose rugs or use non-slip backing.
 • Add night lights in the bedroom, hall, and bathroom.
 • Keep frequently used items at waist height to limit bending and reaching.
Now, if you already use a cane or walker, keep it within reach and use it consistently unless your clinician tells you otherwise.⁷
How should I set up the bathroom for the first week or two? Shower and wound care rules will vary from one medical center to the next, so plan for either sponge baths at first, or careful showering with gentle (pat) drying. Your DBS team may instruct you to keep incisions dry for about 48 hours, then allow light showering while avoiding soaking or scrubbing, and again, patting dry afterward.⁷

Let's look at some basic bathroom safety:
 • Use a non-slip mat in your shower to prevent accidental slips.
 • If you have balance issues outside of your condition that you got DBS installed for, consider getting a shower chair.
 • Try to keep soap, towels, and clean clothes within easy reach. Less stretching will keep you from even further slipping issues.

What supplies should I have ready for incision and wound care? Your DBS surgical team will give you specific instructions, but many aftercare documents emphasize using gentle wound cleaning by keeping your incisions as dry as you can instructed, and definitly avoid soaking in water.⁷,⁸,⁹ Consider doing the following:
 • Use a mild, scent free soap and single-use clean towels.⁷,⁸
 • When dealing with gauze, only it if your discharge plan says to cover a site that rubs on clothing or may "ooze".⁸
 • An often overlooked wound care tool is a small mirror, or your care partner. that can help check behind-the-ear where the connector is typically located and in the areas on your scalp⁷

Be sure to avoid putting peroxide or alcohol on the incision unless your team tells you to, because some aftercare instructions warn these can slow healing, and it probably won't feel great!⁸,⁹ 
Should visitors help with wound care? Usually, less touching is better. The Center for Disease Control advises that care partners and friends shouldn't touch any of your surgical wounds or dressings, and everyone that helps you should clean their hands with an anti-bacterial soap before and after helping with your wound care.³ Johns Hopkins Medicine also advises loved ones not touch the wound, and to follow wound-care instructions carefully.¹⁰ Be sure to put anti-bacterial hand soap or alcohol hand rub anywhere that your wound care would be addressed at home.³

What do I need to plan for meals, hydration, and bathroom habits? Hydration (water specifically!) and regular bathroom habits make a huge difference during your recovery. Drinking more water than not helps you stay hydrated and keep bowel and bladder habits regular.¹¹ Sometimes anesthesia will make your skin dry out, and bowel movements more difficult than necessary and keeping hydrated has an enormous benefit in removing those two potential problems from all of the other things you deal with during your home recovery! It's often recommended to do the following:
 • Before surgery, stock up on easy to cook and eat foods that don't require heavy lifting or long prep.
 • Always keep water within reach in your main resting area, like the living room or bedroom.
 • If constipation has been a problem with past surgeries or pain medicines, bring it up before surgery so your team can plan, and provide medication to help.⁸,¹¹
How should I organize medications and discharge paperwork at home? This is a great question, and not often talked about! Don't change medications unless your DBS medical team directs you. Some DBS discharge guidance will tell you to continue your pre-operative medication schedules until your DBS system has been activated, unless you are instructed otherwise, and specifically get specific instructions for restarting any blood thinners you may be on, if they were withheld for the surgery.¹²,¹³ Some idease we have heard in our DBS Online Zoom Group are as follows:
 • Keep your printed discharge instructions on the fridge or near the bed.³
 • Use a weekly pill organizer and phone alarms.
 • Keep one updated medication list in your wallet, in the notes on your smart phone or device,  keep another list at home.⁸,⁹
What activity restrictions should I plan around at home? Your specific restrictions will vary by neurosurgeon and by the stage of DBS surgery you are at, but many medical centers will advise a period of limited lifting and limited activity. Here are some standard protocols that you will most likely hear:
 • Avoid any strenuous activity, and lifting more than 20 pounds, for about 2 weeks, with walking and light activity being allowed, and encouraged.⁷
 • Next, avoid lifiting activity after those first 2 weeks of more than 5 pounds, with moderate or high-intensity activity limited for 4 to 6 weeks.¹
 • Lastly, avoid activities that strain your chest and upper arem areasfor 4 to 6 weeks, being cautious to avoid raising the arm on the device side above shoulder level. Your medical team will confirm the excercise and lifting regimine for you specifically.⁹ If they don't . . . ASK!
When it come to your home prep that reflect these common weight and excercise limits:
 • Arrange for your care partner or othert to help you with grocery shopping, your laundry, any vacuuming, yard work, and lastly pet care.¹,⁷,⁹
 • Make it a habit of placing frequently used items on no less than waist high counters, and definetly NOT low cabinets.
 • Also, try using smaller containers for laundry and trash to avoid heavy loads.
What discomfort or changes are common, and how do I plan around them? Temporary soreness and swelling at implantation sites are commonly described after DBS surgery.² There may be some bruising near surgery areas and swelling around your eyes which can be normal early on, as well as tenderness or numbness near incisions can last weeks.¹⁴ Many say their scalp feels numb to the touch and that's because they have cut through nerves to get do the surgical procedure, including running the leads from the top of you head, down to the connector behind your ear, and finally down to your batter/generator. This is completly normal, and some find it "itchy" . . . so don't scratch it! Try a wet compress to reduce the itchy feeling. Also it can take a few weeks for those nerves to grow back to take comfort in knowing that that numbness, or itchiness, is just for now and will eventually go away. That length of time is unique to each individual persons ability for their body to heal.
Now, when you get home think about these options for comfort:
 • Extra pillows, with clean scent free pillow cases, to support your head and upper body.
 • Loose, clean (scent free) clothing that won't rub on your incisions.⁸,⁹
 • Create simple schedules that gives you the opportunity to tak rest breaks.¹¹,¹⁴

What is the “honeymoon” or “lesioning” effect, and why does it matter for home planning? Most DBS surgical patients will notice temporary symptom improvement after the lead placement surgery even when the stimulator is not yet activated! This is "honeymoon effect" is best described as a temporary effect from the surgery itself and can last days or weeks depending on your unique bioloy.¹⁴,¹²,⁷  The thing to remember about this is that it can make your symptoms seem better immediatly, then worse again later, which can feel confusing, but when you no longer feel the severity of your symptoms . . . you come to realize what life has been for you, and what you have to look forward to from now on!¹⁴ During this short period of time, some medical teams will be super cautious in not doing any medication changes, especially without your neurologist's approval.

What do I need ready for follow-up visits, activation, and programming? Many DBS medical teams turn your battery/generator weeks after surgery and then adjust your specific settings over multiple visits.² Your post-surgical discharge paperwork may have you already scheduled for a follow-up with your medical team at about the 2 week mark. After that meeting you can discuss your personalized plan of care moving forward. It's recommended to go ahead and schedule those visits at that time.¹²
When you come for your first post-surgery visit you want to make sure that:
 • You have transportation setup, especially if you have appointments early in the day because you won't be cleared to drive yet.¹¹,⁹
 • Bring a small notebook to track your symptoms, any potential side effects, sleep issues, and any medication timing to discuss at your first programming.²,¹² More information is best!
 • Lastly you should create a dedicated place for your DBS equipment, which can include your patient controller, charger (if rechargeable), and your device ID card.¹²,¹³,¹⁵

What should my home plan include for driving and work? Driving restrictions will vary by country, local rules, and your medical situation, so always follow your medical team’s instructions. Some UK DBS discharge guidance advises not to drive for 6 weeks and to notify your DVLA and auto insurer, which may not apply in the US.¹⁵,¹¹ Now, returning to work is going to vary. Some return to work within 1 to 2 weeks, but this depends on what you do for a living, what your recovery has been like, and more importantly what your medical team's guidance will be.⁹

What warning signs should I watch for at home, and when should I call? This is super important! Call your DBS team immediatly if you notice ANY increased redness, warmth, swelling, drainage, fever, or worsening pain at your incision sites. Johns Hopkins Hospital even lists fever, pus, redness, heat, pain, or tenderness as valid reasons to call.¹⁰ Some DBS post-surgical discharge guidance will stay that any redness, tenderness, oozing, fever, and overall feeling unwell as potential signs of device-area infection, and warns that erosion through the skin, as well, shouldn't be ignored.¹²

Lastly, if any symptoms seem urgent or severe, seek emergency care immediately. Even if it turns out to not be something of concern, it's better to address the possibility than deal with dangerous untreated symptoms! Some medical teams and center will even list emergencies such as seizure, passing out, severe confusion, being hard to wake, chest pain, or trouble breathing as reasons to call emergency services.⁸,⁹
Internationally, home-care instructions and timelines can vary across countries and healthcare systems, including driving rules, as previously mentioned, and the typical timing for activation and programming. Always follow the written plan from your own DBS team, and ask for clarification if anything is unclear.³,¹²

Question 10

Sources

Accepted Answer

DBS Medical Team Sources:
1. National Institute of Neurological Disorders and Stroke. Deep Brain Stimulation (DBS). National Institutes of Health. Updated August 1, 2025. Accessed December 29, 2025. NINDS
(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 29, 2025. AANS
(https://www.aans.org/patients/conditions-treatments/deep-brain-stimulation/?utm_source=chatgpt.com)
3. Hassan A, Wu SS, Schmidt P, et al. Deep brain stimulation and electrical neuro-network modulation: clinical outcomes and future directions. Neurology. 2013. Accessed December 29, 2025. American Academy of Neurology
(https://www.neurology.org/doi/10.1212/WNL.0b013e31827f0f91?utm_source=chatgpt.com)
4. Parkinson’s Foundation. Considering Deep Brain Stimulation. Accessed December 29, 2025. Parkinson's Foundation
(https://www.parkinson.org/library/fact-sheets/deep-brain-stimulation?utm_source=chatgpt.com)
5. Boston University Medical Campus. Deep Brain Stimulation Program. Accessed December 29, 2025. Boston University Medical Campus
(https://www.bumc.bu.edu/parkinsonsdisease/brain-stimulation/?utm_source=chatgpt.com)
6. Shukla AW, Okun MS. DBS programming: an evolving approach for patients with Parkinson’s disease. Neurol Res Int. 2017;2017:1-15. Accessed December 29, 2025. PMC
(https://pmc.ncbi.nlm.nih.gov/articles/PMC5632902/?utm_source=chatgpt.com)
7. Moro E, Esselink RJA, Xie J, Hommel M, Benabid AL, Pollak P. The impact on Parkinson’s disease of electrical parameter settings in STN stimulation. JAMA Neurol. 2006. Accessed December 29, 2025. JAMA Network
(https://jamanetwork.com/journals/jamaneurology/fullarticle/792335?utm_source=chatgpt.com)
8. Okun MS, Fernandez HH, et al. Deep brain stimulation and the role of the neuropsychologist. Clin Neuropsychol. 2007. Accessed December 29, 2025. PubMed(https://pubmed.ncbi.nlm.nih.gov/17366283/?utm_source=chatgpt.com)

Pre-Surgical Testing Sources:
1. National Institute of Neurological Disorders and Stroke. Deep Brain Stimulation (DBS). National Institutes of Health. Updated August 1, 2025. Accessed December 29, 2025. NINDS
(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 29, 2025. AANS
(https://www.aans.org/patients/conditions-treatments/deep-brain-stimulation/?utm_source=chatgpt.com)
3. Parkinson’s Foundation. Considering Deep Brain Stimulation. Updated 2021. Accessed December 29, 2025. Parkinson's Foundation
(https://www.parkinson.org/library/fact-sheets/deep-brain-stimulation?utm_source=chatgpt.com)
4. Tröster AI. Some clinically useful information that neuropsychology provides patients, carepartners, neurologists, and neurosurgeons about deep brain stimulation for Parkinson’s disease. Arch Clin Neuropsychol. 2017. Accessed December 29, 2025. PMC
(https://pmc.ncbi.nlm.nih.gov/articles/PMC5860398/?utm_source=chatgpt.com)
5. Epilepsy Foundation. Deep Brain Stimulation for Seizures. Accessed December 29, 2025. Epilepsy Foundation+1(https://www.epilepsy.com/treatment/devices/deep-brain-stimulation?utm_source=chatgpt.com)

DBS MRI, Why Sources:
1. National Institute of Neurological Disorders and Stroke. Deep Brain Stimulation (DBS). National Institutes of Health. Updated August 1, 2025. Accessed December 29, 2025. NINDS
(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 29, 2025. AANS
(https://www.aans.org/patients/conditions-treatments/deep-brain-stimulation/?utm_source=chatgpt.com)
3. Bjartmarz H, Rehncrona S. Comparison of accuracy and precision between frame-based and frameless stereotactic navigation for deep brain stimulation electrode implantation. Stereotact Funct Neurosurg. 2007. Accessed December 29, 2025. PubMed
(https://pubmed.ncbi.nlm.nih.gov/17534136/?utm_source=chatgpt.com)
4. Roth A, Buttrick S, Rohani M, et al. Accuracy of frame-based and frameless systems for deep brain stimulation: a meta-analysis. Stereotact Funct Neurosurg. 2018. Accessed December 29, 2025. PubMed
(https://pubmed.ncbi.nlm.nih.gov/30197058/?utm_source=chatgpt.com)
5. Klassen BT, Okun MS. The modern utility of awake deep brain stimulation surgery. 2025. Accessed December 29, 2025. PMC
(https://pmc.ncbi.nlm.nih.gov/articles/PMC12486036/?utm_source=chatgpt.com)
6. Lozano CS, Lipsman N. Imaging alone versus microelectrode recording guided targeting during deep brain stimulation surgery: an appraisal. J Neurosurg. 2018. Accessed December 29, 2025. The Journal of Neuroscience
(https://thejns.org/view/journals/j-neurosurg/130/6/article-p1847.xml?utm_source=chatgpt.com)
7. Chang B, Horn A, et al. Applying normative atlases in deep brain stimulation. 2024. Accessed December 29, 2025. PMC
(https://pmc.ncbi.nlm.nih.gov/articles/PMC11634178/?utm_source=chatgpt.com)
8. US Food and Drug Administration. Approval information for DBS therapy for epilepsy, Medtronic PMA supplement. Accessed December 29, 2025. PubMed(https://pubmed.ncbi.nlm.nih.gov/30197058/?utm_source=chatgpt.com)

Awake vs Asleep Surgery Sources:
1. Parkinson’s Foundation. Deep Brain Stimulation (DBS). Accessed December 29, 2025. https://www.parkinson.org/living-with-parkinsons/treatment/surgical-treatment-options/deep-brain-stimulation
(https://www.parkinson.org/living-with-parkinsons/treatment/surgical-treatment-options/deep-brain-stimulation?utm_source=chatgpt.com)
2. Mayo Clinic. Deep brain stimulation. Updated September 19, 2023. Accessed December 29, 2025. https://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)
3. Cleveland Clinic. Deep Brain Stimulation (DBS): What It Is, Purpose & Procedure. Accessed December 29, 2025. https://my.clevelandclinic.org/health/treatments/21088-deep-brain-stimulation
(https://my.clevelandclinic.org/health/treatments/21088-deep-brain-stimulation?utm_source=chatgpt.com)
4. Klassen BT, Okun MS. The modern utility of awake deep brain stimulation surgery. Accessed December 29, 2025. https://pubmed.ncbi.nlm.nih.gov/41040688/
(https://pubmed.ncbi.nlm.nih.gov/41040688/?utm_source=chatgpt.com)
5. Holewijn RA, Verbaan D, van den Munckhof P, et al. General anesthesia vs local anesthesia in microelectrode recording guided deep-brain stimulation for Parkinson disease: the GALAXY randomized clinical trial. JAMA Neurol. 2021;78(10):1212-1219. Accessed December 29, 2025. https://jamanetwork.com/journals/jamaneurology/fullarticle/2783978
(https://jamanetwork.com/journals/jamaneurology/fullarticle/2783978?utm_source=chatgpt.com)
6. Holewijn RA, Verbaan D, van den Munckhof P, et al. General anesthesia vs local anesthesia in microelectrode recording guided deep-brain stimulation for Parkinson disease: the GALAXY randomized clinical trial. JAMA Neurol. 2021. Full text (PMC). Accessed December 29, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC8424530/
(https://pmc.ncbi.nlm.nih.gov/articles/PMC8424530/?utm_source=chatgpt.com)
7. Lim ML, Tan AH, Lim SY, et al. Awake versus asleep anesthesia in deep brain stimulation surgery for Parkinson’s disease: a systematic review and meta-analysis. Stereotact Funct Neurosurg. 2024;102(3):141-152. Accessed December 29, 2025. https://pubmed.ncbi.nlm.nih.gov/38636468/
(https://pubmed.ncbi.nlm.nih.gov/38636468/?utm_source=chatgpt.com)
8. Maroufi SF, et al. Awake versus asleep deep brain stimulation for Parkinson’s disease: a systematic review and meta-analysis. J Neurosurg. 2024;142(2):324-337. Accessed December 29, 2025. https://thejns.org/view/journals/j-neurosurg/142/2/article-p324.xml
(https://thejns.org/view/journals/j-neurosurg/142/2/article-p324.xml?utm_source=chatgpt.com)
9. Stenmark Persson R, et al. Awake versus asleep deep brain stimulation targeting the subthalamic nucleus for Parkinson’s disease. npj Parkinsons Dis. 2024. Accessed December 29, 2025. https://www.nature.com/articles/s41531-024-00833-9(https://www.nature.com/articles/s41531-024-00833-9?utm_source=chatgpt.com)

Lead Placement and Targeting Sources:
1. National Institute of Neurological Disorders and Stroke. Deep Brain Stimulation (DBS). National Institutes of Health. Updated August 1, 2025. Accessed December 29, 2025. NINDS
(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 29, 2025. AANS
(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 29, 2025. Mayo Clinic
(https://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562?utm_source=chatgpt.com)
4. Pluta RM, et al. Deep Brain Stimulation. JAMA. 2011. Accessed December 29, 2025. JAMA Network
(https://jamanetwork.com/journals/jama/fullarticle/645662?utm_source=chatgpt.com)
5. MedlinePlus Medical Encyclopedia. Deep brain stimulation. Updated December 31, 2023. Accessed December 29, 2025. MedlinePlus
(https://medlineplus.gov/ency/article/007453.htm?utm_source=chatgpt.com)
6. Johns Hopkins Medicine. Deep Brain Stimulation. Accessed December 29, 2025. Johns Hopkins Medicine
(https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/deep-brain-stimulation?utm_source=chatgpt.com)
7. Parkinson’s Foundation. Deep Brain Stimulation (DBS). Accessed December 29, 2025. Parkinson's Foundation
(https://www.parkinson.org/living-with-parkinsons/treatment/surgical-treatment-options/deep-brain-stimulation?utm_source=chatgpt.com)
8. National Institute of Neurological Disorders and Stroke. NINDS Contributions to Approved Therapies: DBS for Parkinson’s disease and other movement disorders. Updated December 3, 2024. Accessed December 29, 2025. NINDS
(https://www.ninds.nih.gov/about-ninds/what-we-do/impact/ninds-contributions-approved-therapies/deep-brain-stimulation-dbs-treatment-parkinsons-disease-and-other-movement-disorders?utm_source=chatgpt.com)
9. Congress of Neurological Surgeons. Guidelines on Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation for Parkinson’s Disease. Accessed December 29, 2025. CNS
(https://www.cns.org/guidelines/subthalamic-nucleus-globus-pallidus-intermus-deep-brain-stimulation-parkinson/congress-of-neurological-surgeons-systematic-revie?utm_source=chatgpt.com)
10. US Food and Drug Administration. Premarket Approval (PMA) P960009/S219: Medtronic DBS System for Epilepsy, anterior nucleus of the thalamus indication. Accessed December 29, 2025. FDA Access Data
(https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=p960009s219&utm_source=chatgpt.com)
11. Burchiel KJ, McCartney S, Lee A, Raslan AM. Accuracy of deep brain stimulation electrode placement using intraoperative computed tomography without microelectrode recording. J Neurosurg. 2013;119(2):301-306. Accessed December 29, 2025. The Journal of Nuclear Medicine
(https://thejns.org/view/journals/j-neurosurg/119/2/article-p301.xml?utm_source=chatgpt.com)
12. Lozano CS, Ranjan M, Boutet A, et al. Imaging alone versus microelectrode recording guided targeting of the subthalamic nucleus in Parkinson’s disease. J Neurosurg. 2018. Accessed December 29, 2025. PubMed
(https://pubmed.ncbi.nlm.nih.gov/30074454/?utm_source=chatgpt.com)
13. Horn A, Kühn AA. Lead-DBS: A toolbox for deep brain stimulation electrode localizations and visualizations. Neuroimage. 2015. Accessed December 29, 2025. PubMed
(https://pubmed.ncbi.nlm.nih.gov/25498389/?utm_source=chatgpt.com)
14. Mayo Clinic. Deep brain stimulation: Precision using segmented leads. Published January 29, 2019. Accessed December 29, 2025. Mayo Clinic MedProf Videos(https://medprofvideos.mayoclinic.org/videos/deep-brain-stimulation-precision-using-segmented-leads?utm_source=chatgpt.com)

Anesthesia and Pain Control Sources:
1. Janssen MLF, et al. Considerations for anesthesia. Deep Brain Stimulation Journal. 2024. Accessed December 29, 2025. https://www.dbsjournal.com/article/S2949-6691%2823%2900020-9/fulltext
(https://www.dbsjournal.com/article/S2949-6691%2823%2900020-9/fulltext?utm_source=chatgpt.com)
2. Lim ML, et al. Awake versus asleep anesthesia in deep brain stimulation: review. 2024. Accessed December 29, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC11152021/
(https://pmc.ncbi.nlm.nih.gov/articles/PMC11152021/?utm_source=chatgpt.com)
3. Holewijn RA, et al. General anesthesia vs local anesthesia in microelectrode recording guided DBS for Parkinson disease: randomized clinical trial. JAMA Neurol. 2021. Accessed December 29, 2025. https://jamanetwork.com/journals/jamaneurology/fullarticle/2783978
(https://jamanetwork.com/journals/jamaneurology/fullarticle/2783978?utm_source=chatgpt.com)
4. Persson RS, et al. Awake versus asleep deep brain stimulation targeting the subthalamic nucleus. 2024. Accessed December 29, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC11584744/
(https://pmc.ncbi.nlm.nih.gov/articles/PMC11584744/?utm_source=chatgpt.com)
5. Cleveland Clinic. Deep Brain Stimulation (DBS). Accessed December 29, 2025. https://my.clevelandclinic.org/health/treatments/21088-deep-brain-stimulation
(https://my.clevelandclinic.org/health/treatments/21088-deep-brain-stimulation?utm_source=chatgpt.com)
6. Mayo Clinic. Deep brain stimulation. Updated September 19, 2023. Accessed December 29, 2025. https://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)
7. Parkinson’s Foundation. Deep Brain Stimulation (DBS). Accessed December 29, 2025. https://www.parkinson.org/living-with-parkinsons/treatment/surgical-treatment-options/deep-brain-stimulation
(https://www.parkinson.org/living-with-parkinsons/treatment/surgical-treatment-options/deep-brain-stimulation?utm_source=chatgpt.com)
8. UW Medicine Patient Education. Deep Brain Stimulation (DBS): Essential Tremor. August 2025. Accessed December 29, 2025. https://healthonline.washington.edu/sites/default/files/record_pdfs/Deep-Brain-Stimulation-DBS-Essential-Tremor_08-2025%20.pdf
(https://healthonline.washington.edu/sites/default/files/record_pdfs/Deep-Brain-Stimulation-DBS-Essential-Tremor_08-2025%20.pdf?utm_source=chatgpt.com)
9. Brigham and Women’s Hospital Neurosurgery. Activity After Your Brain Surgery, Post-Op Education. Accessed December 29, 2025. https://www.brighamandwomens.org/assets/BWH/neurosurgery/pdfs/brain-surgery-post-op-education.pdf
(https://www.brighamandwomens.org/assets/BWH/neurosurgery/pdfs/brain-surgery-post-op-education.pdf?utm_source=chatgpt.com)
10. Grant R, et al. Anaesthesia for deep brain stimulation: a review. Br J Anaesth. 2015. Accessed December 29, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC4663044/
(https://pmc.ncbi.nlm.nih.gov/articles/PMC4663044/?utm_source=chatgpt.com)
11. Jin H, et al. Comparative study of asleep and awake deep brain stimulation. NPJ Parkinsons Dis. 2020. Accessed December 29, 2025. https://www.nature.com/articles/s41531-020-00130-1(https://www.nature.com/articles/s41531-020-00130-1?utm_source=chatgpt.com)

Infection Prevention Sources:
1. Abode-Iyamah KO, Chiang HY, Woodroffe RW, et al. Deep brain stimulation hardware related infections, 10-year experience at a single institution. J Neurosurg. 2018;130(2):629-636. Accessed December 30, 2025. https://thejns.org/view/journals/j-neurosurg/130/2/article-p629.xml
(https://thejns.org/view/journals/j-neurosurg/130/2/article-p629.xml?utm_source=chatgpt.com)
2. Bjerknes S, Skogseid IM, Sæhle T, Dietrichs E, Toft M. Surgical site infections after deep brain stimulation surgery, frequency and risk factors at a single center. PLoS One. 2014;9(8):e105288. Accessed December 30, 2025. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0105288
()
3. Tabaja H, Zhang M, Mara KC, et al. Deep brain stimulator device infection: the Mayo Clinic Rochester experience. Open Forum Infect Dis. 2022;9(12):ofac630. Accessed December 30, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC9830487/
(https://pmc.ncbi.nlm.nih.gov/articles/PMC9830487/?utm_source=chatgpt.com)
4. AANS. Deep Brain Stimulation. Accessed December 30, 2025. https://www.aans.org/patients/conditions-treatments/deep-brain-stimulation/
(https://www.aans.org/patients/conditions-treatments/deep-brain-stimulation/?utm_source=chatgpt.com)
5. Dere ÜA, Yıldırım AE, Taş M, et al. Postoperative infection problems in deep brain stimulation applications. Deep Brain Stimulation. 2023. Accessed December 30, 2025. https://www.dbsjournal.com/article/S2949-6691%2823%2900013-1/fulltext
(https://www.dbsjournal.com/article/S2949-6691%2823%2900013-1/fulltext?utm_source=chatgpt.com)
6. Kantzanou M, Karaviti K, Kazis D, et al. Deep brain stimulation related surgical site infections. Clin Neurol Neurosurg. 2021;206:106696. Accessed December 30, 2025. https://pubmed.ncbi.nlm.nih.gov/33462954/
(https://pubmed.ncbi.nlm.nih.gov/33462954/?utm_source=chatgpt.com)
7. Yoo H, Lee JH, Kim JH, et al. Risk factor analysis and algorithmic approach for deep brain stimulation wound complications. J Wound Manag Res. 2024. Accessed December 30, 2025. https://www.jwmr.org/include/download.php?filedata=503%7Cjwmr-2024-03062.pdf
(https://www.jwmr.org/include/download.php?filedata=503|jwmr-2024-03062.pdf&utm_source=chatgpt.com)
8. Abbott. Important Safety Information, Neuromodulation. Accessed December 30, 2025. https://www.neuromodulation.abbott/us/en/important-safety-information.html
(https://www.neuromodulation.abbott/us/en/important-safety-information.html?utm_source=chatgpt.com)
9. Medtronic. Deep brain stimulation, important safety information. Accessed December 30, 2025. https://www.medtronic.com/en-us/l/patients/treatments-therapies/what-is-dbs/important-safety-information.html
(https://www.medtronic.com/en-us/l/patients/treatments-therapies/what-is-dbs/important-safety-information.html?utm_source=chatgpt.com)
10. National Institute for Health and Care Excellence. Surgical site infections: prevention and treatment (NG125). Published April 11, 2019. Last updated August 19, 2020. Accessed December 30, 2025. https://www.nice.org.uk/guidance/ng125/chapter/recommendations
(https://www.nice.org.uk/guidance/ng125/chapter/recommendations?utm_source=chatgpt.com)
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Home Prep Sources:
1. Cleveland Clinic. Deep Brain Stimulation (DBS): What It Is, Purpose and Procedure. Accessed December 30, 2025. https://my.clevelandclinic.org/health/treatments/21088-deep-brain-stimulation
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4. Beth Israel Deaconess Medical Center. DBS General Guide, Movement Disorders Center. Accessed December 30, 2025. https://research.bidmc.org/movement-disorders/dbs-general-guide
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