How Deep Brain Stimulation is Evolving Parkinson Disease

As Parkinson disease (PD) progresses, many patients reach a point where medication alone is no longer sufficient to control symptoms such as tremor, rigidity, slowness, and motor fluctuations. For these individuals, deep brain stimulation (DBS) has become an increasingly important treatment option, offering targeted neuromodulation to help improve motor control and reduce the burden associated with escalating medication schedules.

Often described as a “pacemaker for the brain,” DBS works by delivering electrical stimulation to specific brain regions involved in motor circuitry. Over the last several years, the field has continued to evolve through innovations such as directional leads, adaptive programming strategies, and remote care technologies aimed at personalizing therapy and improving long-term patient management. At the same time, clinicians are reassessing the timing of referral for DBS evaluation, particularly as newer infusion therapies and investigational disease-modifying approaches continue to emerge within Parkinson disease care.

During PD Awareness Month (April), NeurologyLive^® spoke with Rebecca Wilkins, Divisional Vice President of R&D Neuromodulation at Abbott, about the current state of DBS technology and how the treatment landscape is changing. In the discussion, Wilkins outlined the mechanistic rationale behind DBS, key considerations for patient selection, and the ways newer neuromodulation technologies may influence programming strategies and patient outcomes moving forward.

Can you outline how DBS modulates basal ganglia circuitry and how this translates into improvements in motor symptoms for patients with Parkinson's disease?

Rebecca Wilkins: Deep brain stimulation (DBS) works by delivering precisely timed electrical pulses to specific areas within the brain's basal ganglia circuitry, which are involved in motor control, to help control PDP symptoms.¹ DBS systems include two main components that facilitate this process:

• An implantable pulse generator (IPG), a small device placed under the skin of the chest, produces these electrical pulses.
• Thin wires, known as leads, are surgically implanted to deliver these electrical pulses directly to the targeted brain regions. These DBS systems can utilize two different types of batteries: rechargeable and non-rechargeable.
• These electrical outputs function much like a pacemaker for the brain, disrupting abnormal, overactive brain signals to provide significant improvements in motor symptoms for patients with PD, particularly when medication alone is no longer sufficient.
• DBS offers an advantage by reducing the burden of the strict medication schedule often associated with pharmaceutical management, while also providing relief for all the major symptoms of PD. It is particularly beneficial in improving movement symptoms, such as tremor, stiffness, and slowness, especially when these symptoms respond to levodopa.
• It should be noted that tremor itself can improve with DBS even if it has not responded to levodopa.
• Furthermore, DBS effectively addresses medication side effects, including dyskinesia (extra, involuntary movements), either directly or by enabling lower medication doses. This improves "on time" without bothersome dyskinesias and ensures sustained symptom improvement for patients with PD.³

What are the most important clinical factors that guide patient selection for DBS today, and have these considerations evolved in recent years?

• The most important clinical factors guiding patient selection for deep brain stimulation (DBS) primarily include the patient's response to pharmaceutical intervention, the assessment of their motor fluctuations, their cognitive status, and the physical health of their brain. Physicians will typically consider DBS when conventional medication is no longer sufficient to manage PD symptoms.
• Patients typically undergo a thorough neurological assessment using the Core Assessment Program for Surgical Interventional Therapies in Parkinson’s disease (CAPSIT-PD), which evaluates self-reported motor fluctuations, particularly “off times,” often through home diaries completed over several days.³
• MRIs of the brain, both with and without contrast, are also performed to assess the brain's physical health and structure to ensure surgical feasibility. These considerations have evolved into a structured, multi-faceted screening process that emphasizes both the patient's motor symptom profile and overall cognitive and brain health to optimize surgical outcomes.
• It is important to note that DBS surgery is not recommended for individuals with severe cognitive impairments, such as dementia or memory issues, because the procedure could exacerbate these conditions; therefore, a comprehensive medical, psychosocial, and cognitive examination is crucial for eligibility.⁴

For patients with motor fluctuations or dyskinesias despite optimized therapy, how should clinicians approach the timing of referral for DBS evaluation?

• The ideal window for DBS is when a patient still responds well to levodopa but can no longer achieve stable motor control through medication alone.⁵
• This period is often the window of opportunity where DBS can offer the most sustained benefit.⁶
• Early referral can help prevent excessive medication burden and a significant decline in quality of life.⁴
• This recommendation is the same for people who are experiencing motor fluctuations or dyskinesias despite optimized therapy.

How have newer technologies, such as directional leads or adaptive stimulation, influenced programming strategies and patient outcomes?

• Newer technologies have shifted programming by improving precision and personalization of therapy.
• Directional leads, for example, allow clinicians to deliver electrical currents with greater accuracy, optimizing therapeutic effects and minimizing side effects in specific brain regions. 
• That added level of control can expand the therapeutic window and make programming more efficient and tailored to the individual patient.
• Additionally, innovations like Abbott's NeuroSphere™ Virtual Clinic are revolutionizing how care is delivered by expanding access to care for people who live far from their doctors. This first-of-its-kind technology in the U.S. allows people to communicate with their doctors, ensure proper settings and functionality, and receive new treatment settings remotely* as needed.
• Abbott's NeuroSphere Virtual Clinic gives people the flexibility and comfort of receiving care anywhere* by connecting with their doctor via secure in-app video chat and an integrated remote programming feature, now available within the proprietary Abbott patient controller app.
• This significantly reduces the burden of travel and appointments, ensuring that patients can maintain optimal symptom control regardless of their geographical location.
• Together, these technologies are helping us move toward a more responsive, patient-specific approach to DBS by making it more dynamic, personalized, and responsive to individual patient needs. This, in turn, could lead to superior and more consistent patient outcomes, improving symptom control and overall quality of life.

*Anywhere with a Wi-Fi or cellular connection and sufficiently charged patient controller.

As the treatment landscape expands, how do you see DBS fitting alongside infusion-based therapies and emerging disease-modifying approaches?

• DBS is an established treatment option for delivering meaningful improvements in motor symptoms, particularly for patients who still respond to levodopa but are struggling with motor fluctuations or dyskinesias that are difficult to manage with medication alone.
• As new infusion-based therapies and disease-modifying approaches emerge, DBS has shifted from being a standalone intervention to being increasingly used in tandem with these other methods to provide comprehensive, personalized symptom management for PD.
• Infusion-based therapies and disease-modifying approaches often aim to address underlying pathology or provide more precise drug delivery. However, they may not provide the immediate, robust, and reversible symptomatic relief that DBS offers for severe motor symptoms such as tremor, rigidity, and dyskinesia.
• DBS will continue to be a crucial option when oral medications are no longer sufficient to manage these debilitating symptoms, and for patients whose symptoms are complex, a combination of targeted drug delivery via infusion and precise electrical stimulation via DBS could offer a more tailored and effective therapeutic profile.
• Looking ahead, disease-modifying therapies hold a lot of promise, but they are still largely in development. Even as those therapies emerge, there will continue to be a need to manage symptoms and maintain quality of life. We expect DBS to remain a key part of that paradigm, working alongside other treatments in a more integrated, patient-centric approach to care.
• For patients who have already received DBS, disease-modifying therapies could, in theory, create a healthier brain environment. This might lead to improved responsiveness to DBS, potentially allowing for lower stimulation settings, extending battery life, or even enhancing the overall therapeutic window of the implanted device.

REFERENCES
1. Fang, J. Y., & Tolleson, C. (2017). The role of deep brain stimulation in Parkinson's disease: an overview and update on new developments. Neuropsychiatric disease and treatment, 13, 723–732. https://doi.org/10.2147/NDT.S113998
2. Hariz, M., & Blomstedt, P. (2022). Deep brain stimulation for Parkinson's disease. Journal of internal medicine, 292(5), 764–778. https://doi.org/10.1111/joim.13541
3. National Institute of Health. Core Assessment Program for Surgical Interventional Therapies in PD (CAPSIT-PD). Accessed April 16, 2026. https://cde-fe.ninds.nih.gov/ninds/noc-report/F3004/Core%20Assessment%20Program%20for%20Surgical%20Interventional%20Therapies%20in%20PD%20(CAPSIT-PD)
4. Cedars Sinai. Deep Brain Stimulation (DBS) Evaluation, Tests and Surgery. Accessed April 16, 2026. https://www.cedars-sinai.org/content/dam/cedars-sinai/programs-and-services/neurology/memory-disorder/deep-brain-stimulation-evaluation-tests-and-surgery.pdf
5. Hartmann CJ, Fliegen S, Groiss SJ, Wojtecki L, Schnitzler A. An update on best practice of deep brain stimulation in Parkinson’s disease. Ther Adv Neurol Disord. 2019 Mar 28;12:1756286419838096. doi: 10.1177/1756286419838096. PMID: 30944587; PMCID: PMC6440024.
6. deSouza RM, Moro E, Lang AE, Schapira AH. Timing of deep brain stimulation in Parkinson disease: a need for reappraisal? Ann Neurol. 2013 May;73(5):565-75. doi: 10.1002/ana.23890. PMID: 23483564; PMCID: PMC4065356.