Parkinson’s Disease
A progressive condition of movement — but one where the right treatment, chosen at the right stage, can return years of independence.
Treatment
Deep Brain Stimulation (DBS)
A reversible, adjustable procedure that quiets the abnormal brain signals behind tremor, rigidity and involuntary movement — when medication alone no longer holds the day together.
What is deep brain stimulation?
Deep brain stimulation is a surgical treatment in which thin electrodes are placed in a precisely targeted area of the brain and connected to a small pulse generator implanted under the skin of the chest. The generator sends continuous, finely tuned electrical impulses that interrupt the irregular signalling responsible for tremor, stiffness and involuntary movement.
It is often described as a brain pacemaker, and the comparison is a fair one: nothing is removed or destroyed, the stimulation can be adjusted from outside the body at any time, and the whole system can be switched off or removed if it no longer serves the patient. That reversibility is the single most important difference between DBS and lesioning procedures such as MRgFUS.
DBS has been in clinical use since the late 1990s and is an established, guideline-supported option for Parkinson’s disease, essential tremor and dystonia. It is not experimental.
How it works
In movement disorders, specific circuits deep in the brain fire in an abnormal, over-synchronised rhythm. Medication tries to correct this chemically, which is why its effect rises and falls with each dose. DBS works electrically and continuously, which is why it smooths out the peaks and troughs that medication alone leaves behind.
The target is chosen according to the condition and the symptoms that trouble the patient most:
| Target | Typically used for | What it addresses |
|---|---|---|
| STN — subthalamic nucleus | Parkinson’s disease | Tremor, rigidity, slowness; often allows the largest medication reduction |
| GPi — globus pallidus internus | Parkinson’s disease, dystonia | Involuntary movements (dyskinesia), abnormal postures |
| VIM — thalamic nucleus | Essential tremor | Tremor specifically |
Who is a suitable candidate?
Candidacy is decided case by case, but most patients who benefit share the following pattern.
The levodopa response matters more than any other single factor. As a rule of thumb, symptoms that improve when medication is working are the symptoms likely to improve with DBS; symptoms that never respond to medication — with the important exception of tremor — usually do not respond to stimulation either.
DBS is generally not recommended where there is significant cognitive decline, uncontrolled depression, an unstable medical condition, or a diagnosis of atypical parkinsonism (such as multiple system atrophy or progressive supranuclear palsy) rather than Parkinson’s disease itself. Part of the value of a proper assessment is ruling these out before anyone books a flight.
- A diagnosis of Parkinson’s disease for at least 4–5 years
- A good response to Parkinson’s medication — especially levodopa — but a response that wears off sooner than it used to
- Involuntary movements (dyskinesia) caused by the higher medication doses now needed
- Tremor that has not responded adequately to medication
- No severe psychiatric illness and no advanced memory loss or dementia
- General health sufficient for a planned neurosurgical procedure
How we assess candidacy before you travel
We will not ask you to travel without a preliminary assessment. Before any plan is made, we ask for:
- Recent neurologist reports
- Recent brain MRI scans
- A detailed, current medication list with doses and timings
- Video of the motor symptoms — tremor, walking, stiffness — recorded both “on” and “off” medication
The videos carry more weight than most people expect. A two-minute recording of walking before the first morning dose tells the surgical team more than several pages of correspondence.
Once you arrive, the team will repeat imaging and pre-operative tests. This is not duplication for its own sake: stereotactic targeting requires high-resolution, protocol-specific scans acquired on the same equipment used to plan the operation.
The procedure, step by step
DBS is carried out in two stages, usually a few days apart.
Stage one — placing the electrodes. A stereotactic frame or frameless navigation system fixes the head in a known position relative to the planning scans. Small openings are made in the skull and the electrodes are advanced to the planned target. For much of this stage the patient is awake and comfortable, because the team needs to confirm the target by testing: stimulation is delivered and the patient reports what they feel while the team observes tremor and rigidity directly.
Stage two — placing the generator. Under general anaesthesia, the pulse generator is implanted under the skin below the collarbone and connected to the electrodes by leads tunnelled under the skin of the neck. Nothing is visible from the outside once healing is complete.
Being awake is not as daunting as it sounds. The brain itself has no pain receptors and local anaesthetic covers the scalp. Patients tend to describe the experience as long rather than painful. If you would struggle to stay still or to communicate, tell us — asleep techniques exist and the team will discuss whether one is appropriate for you.
Recovery and programming
The stimulator is generally not switched on immediately. Swelling around the electrodes produces a temporary improvement in symptoms — the so-called microlesion effect — that would make early settings misleading. Programming usually begins a few weeks after surgery.
Programming is a process, not an appointment. Over several sessions the team adjusts contact selection, voltage, pulse width and frequency while medication is reduced in parallel. Much of the benefit patients remember comes from this phase rather than from the operation itself, which is why we ask patients to plan a stay of three to four weeks rather than a surgical week alone.
Do not book a flight home for the week after surgery. Air travel is generally restricted for at least 10–14 days, because cabin pressure changes can be dangerous while small amounts of air may remain trapped inside the skull (pneumocephalus).
What DBS does — and what it does not do
DBS does not cure Parkinson’s disease and does not stop it progressing. What it reliably does, in appropriately selected patients, is:
- lengthen the “on” periods when medication is working
- reduce tremor, rigidity and slowness during those periods
- reduce medication-induced involuntary movements
- allow a meaningful reduction in daily medication dose
Symptoms that tend not to improve include balance problems already present in the best “on” state, freezing of gait that does not respond to medication, and cognitive symptoms. Being clear about this before surgery is the difference between a patient who is satisfied afterwards and one who is disappointed despite an objectively good result.
Risks and trade-offs
DBS is a neurosurgical procedure and carries real, if uncommon, risks. These include bleeding within the brain, infection around the hardware, lead migration or fracture, seizure, and stimulation-related side effects such as changes in speech, balance or mood. Most stimulation-related effects can be reduced or removed by reprogramming, which is one of the practical advantages of a reversible system.
The pulse generator has a finite battery. Non-rechargeable devices are typically replaced after several years in a short procedure; rechargeable devices last considerably longer but require regular charging at home. Your surgeon will discuss which suits your circumstances — including how easily you could return for a replacement.
Your consultation will include figures specific to your case. We do not publish blanket complication rates on this page: a number quoted without the context of age, comorbidity and target is not information.
DBS or MRgFUS?
They are different procedures, not better and worse versions of the same one. The decision follows the patient’s condition.
Read the full comparison on the MRgFUS page, or send us your records and we will tell you which one your case actually points to.
| Criterion | Deep Brain Stimulation | MRgFUS |
|---|---|---|
| Procedure type | Surgical — openings in the skull, implanted hardware | Incisionless — focused sound waves, no implant |
| Sides treated | Usually both sides of the brain | Usually one side |
| Reversibility | Reversible and adjustable from outside | Creates a permanent lesion; irreversible |
| Symptoms targeted | Tremor, slowness, rigidity, involuntary movements | Primarily medication-resistant tremor |
| Typically suits | Mid to advanced stage patients with medication side effects | Patients unsuitable for open surgery, with one-sided tremor |
| Stay in Istanbul | 3–4 weeks | 5–7 days |
DBS at HealBridge
Surgery is performed at PARMER, Medipol Acıbadem District Hospital — a JCI-accredited centre within Medipol Health Group, with the neurosurgical imaging and intensive care infrastructure that functional neurosurgery requires.
Around the surgical team, one coordinator stays with you: preliminary assessment, invitation letter for your visa, airport transfer, a medical interpreter in the operating room, accommodation near the hospital, and the follow-up calls after you fly home. Interpretation matters more here than in most procedures — during awake targeting you need to be able to say “my hand is tingling” and be understood immediately.
Follow-up is scheduled, not improvised: video consultations at 1 week, 1 month, 3 months and 6 months, coordinated with your neurologist at home.
Conditions treated
Frequently asked questions
Does brain pacemaker surgery completely cure Parkinson’s?
No. It does not eliminate the disease or stop it progressing. What it does is extend the “on” periods when medication is effective, substantially reduce tremor and stiffness, and allow a reduction in the medication dose the patient takes.
Can we find out whether the patient is a candidate before booking flights?
Yes, and we will not ask you to travel without it. We request neurologist reports, recent brain MRIs, a detailed medication list, and video of the motor symptoms recorded both “on” and “off” medication. The assessment is free.
Do the tests have to be repeated once we arrive?
Almost always. Even with scans from home, the surgical team needs its own high-resolution, protocol-specific imaging for stereotactic targeting, plus fresh pre-operative clearances taken a few days before the procedure.
How long do we need to stay in Istanbul?
Plan for a minimum of three to four weeks. That covers pre-operative evaluation, both stages of surgery, hospital recovery, wound checks, and the first weeks of device programming — which is where much of the benefit is actually achieved.
Is it safe to fly home after brain surgery?
Not immediately. Air travel is generally restricted for at least 10–14 days after DBS, because cabin pressure changes can be dangerous while small amounts of air may remain trapped inside the skull (pneumocephalus).
Will there be a language barrier during awake surgery?
During targeting the patient needs to be awake and able to report what they feel. We provide dedicated medical interpreters fluent in languages including English, Arabic, Russian and Spanish, so that you are understood in the moment it matters.
What happens if I need revision surgery after I go home?
Your care does not end at the airport. Complications are evaluated remotely first; if a revision is medically necessary, your return to Istanbul is organised under the terms of the medical warranty and protection policies included in your treatment package.
Not sure where to start?
Send us your reports and a short note. A coordinator replies within one working day — no cost, no obligation.