Insights from Dr. Rob Izor, MD — 20+ years programming DBS across all major platforms.
If you or a loved one is considering deep brain stimulation (DBS) for Parkinson’s disease, essential tremor, or dystonia, you’ve probably heard a lot about the devices from Medtronic, Boston Scientific, and Abbott — directional leads, sensing technology, remote programming. After more than two decades programming DBS patients on every major system, here is what I can tell you: the device is important, but it is far from the most important factor in your long-term success.
The best DBS outcomes come from a partnership between the patient, neurologist, neurosurgeon, and programming team. What truly drives excellent outcomes is careful patient selection, precise lead placement during surgery, and expert, unhurried programming afterward. Head-to-head studies comparing real-world results across centers are surprisingly limited, so patients are too often left navigating marketing claims instead of clear information about what actually matters. This page is here to help fix that.
“DBS can be life-changing — but the center and team you choose matter far more than the brand name on the pulse generator.”
What Actually Determines Your DBS Outcome
In order of importance:
- The right patient and target — thorough candidacy evaluation and the correct brain target for your specific symptoms.
- Precise lead placement — unhurried, individualized surgical planning.
- Expert, unhurried programming — the ongoing work that unlocks the device’s full potential.
- …then the device itself.
Getting the Right Patient and Target Selected
DBS works best for the right people. We use a thorough multidisciplinary evaluation — neurology, neurosurgery, neuropsychology, and more — to confirm the diagnosis, ensure a strong medication response where applicable, rule out conditions that respond less well, and set realistic expectations together. If you are still weighing whether DBS is right for you, our Deep Brain Stimulation overview explains candidacy in detail.
Target selection is equally critical:
- Subthalamic nucleus (STN) — for many with Parkinson’s, this target allows the biggest reduction in medications.
- Globus pallidus internus (GPi) — another key Parkinson’s target, often preferred when troublesome dyskinesias (involuntary movements) or certain cognitive or mood concerns are part of the picture.
- VIM thalamus — often the ideal target for tremor.
- Each target has trade-offs; the best choice considers your unique symptoms, goals, and overall health.
Beyond controlling symptoms, early research suggests these targets may also influence broader brain networks involving gamma rhythms — brain-wave patterns that some studies associate with better movement and thinking. This science is still emerging, and we’re careful not to overpromise on it.
Surgical Precision: Planning in Advance
At our center, surgical planning is deliberate and done in advance. We work closely with experienced functional neurosurgeons and multidisciplinary teams to ensure every stage of the process, from candidacy evaluation through implantation and long-term programming, receives the same level of attention. We review each case days in advance to ensure high-quality imaging and to identify the absolute best entry point and trajectory — with no time pressure in the operating room to rush this step. This allows us to:
- Choose trajectories that avoid blood vessels and sulci, reducing bleeding risk.
- Steer clear of the caudate nucleus in STN cases to lower the chance of cognitive side effects.
- Optimize the angle and lead position within the therapeutic target area.
- Maximize benefit while minimizing stimulation-induced side effects that often limit results.
Awake vs. “Asleep” DBS
Modern “asleep” DBS — performed under general anesthesia with imaging guidance — is a legitimate, effective approach that many centers use, and it is more comfortable for some patients. Awake procedures with microelectrode recording and stimulation testing add real-time physiological feedback that can help confirm optimal positioning. Neither approach is universally “better” — the right choice depends on your anatomy, your condition, and your preferences. Our priority is simply that whichever approach we choose, it is chosen for your benefit and on the evidence for your anatomy and condition — not on which is faster to perform.
Bottom line: Precise lead placement is foundational. No device or programming trick can fully overcome a suboptimally placed lead.
What to Expect — and How We Keep You Safe
It’s completely normal to feel anxious about the idea of brain surgery. Here is a plain-language picture of what DBS involves and the steps we take to protect you.
- It’s done in stages, not one long operation. The electrode and the pulse generator are placed in separate, planned steps, with recovery time between them.
- It’s adjustable — and reversible. Unlike older procedures such as pallidotomy or thalamotomy, DBS does not destroy brain tissue. Settings can be fine-tuned over time, and the system can be turned off or removed if needed.
- You are guided every step of the way. Your team supports you before, during, and long after surgery — through candidacy evaluation, the procedure itself, and years of programming and follow-up.
- Your timeline is personalized. We will give you a realistic picture of recovery and what to expect at each stage, based on your health and your specific procedure.
Like any brain surgery, DBS does carry risks, including a small chance of bleeding or infection. The precise, unhurried planning described above is exactly how we work to keep those risks as low as possible — and we will walk you through your individual risks honestly, in plain language, before you decide anything.
The Devices and Programming: Real-World Differences
All three systems now offer directional leads that help steer current away from side effects. Where they differ:
- Abbott — pioneered directional technology in the US and offers an excellent remote iOS platform for quick telemedicine adjustments.
- Boston Scientific — provides the most granular control through its MICC technology, allowing sophisticated bipolar and multi-polar configurations.
- Medtronic — offers strong sensing capabilities but has more limitations in directional bipolar setups: individual segments at the same level must share polarity, which can make it harder to deliver and tolerate higher currents safely when targeting specific networks.
Emerging research is genuinely interesting: some early studies suggest DBS may improve mitochondrial function, reduce oxidative stress, and encourage beneficial gamma entrainment — effects that appear to overlap with non-invasive 40 Hz stimulation research and could, in time, support longer-term brain health. It’s important to be clear that this work is still preliminary and not a promised outcome of DBS. What we can say with confidence is that thoughtful, unhurried programming gives us the best chance to explore these possibilities safely as the evidence matures.
High volume can be a real asset — experienced teams often have excellent outcomes. The challenge is time: when schedules are tight, the follow-up programming that unlocks a device’s full potential can get short-changed, which may mean more medication reliance or side effects than necessary. What separates centers is programming expertise and a willingness to keep refining — directional current, interleaving, and iterative adjustment over years.
What Sets Our DBS Programming Apart
At Neurology Solutions, DBS is directed by a neurologist fellowship-trained in movement disorders and deep brain stimulation, who has been involved in more than 400 DBS procedures since 2005. That subspecialty depth shows up in four places:
- Deliberate pre-surgical planning and candidacy evaluation.
- The approach (awake vs. asleep) and trajectory that optimize placement and safety for you.
- Programming expertise across platforms — including directional current delivery and interleaving — with parameters aimed at both symptom control and emerging brain-network benefits.
- Ongoing optimization, including programming through telemedicine, and second opinions on devices implanted elsewhere.
DBS outcomes depend far more on candidacy, placement, and programming expertise than on which manufacturer’s device you receive. That expertise is what we bring.
Your DBS Center Evaluation Checklist
Whether or not you choose us, these are the questions we believe every patient and family should ask any DBS center before moving forward:
- How many DBS patients does your team evaluate and program each year — and how much time is set aside for each programming visit?
- Who plans the surgical trajectory, and how far in advance is my case reviewed?
- Do you offer both awake and asleep approaches, and how do you decide which is right for me?
- Which brain target — STN, GPi, or VIM — do you recommend for my condition, and why?
- Which device platforms do you work with, and are you independent of any single manufacturer?
- Who performs my long-term DBS programming?
- How often are programming visits typically scheduled after surgery?
- Do you offer remote or telemedicine programming for follow-up?
- What are my individual risks — and what is the plan if my results aren’t what we hoped?
If a center can’t answer these clearly, that tells you something important. If you’d like, we’re happy to answer every one of them for you.
Already Have a DBS Device? Get a Second Opinion
If your device was implanted elsewhere and isn’t performing the way you hoped, you don’t necessarily need more surgery — you may need better programming. Our team offers troubleshooting evaluations for patients with already-implanted DBS devices, pairing an experienced DBS programmer with direct analysis and supervision by Dr. Izor. You can find full details on our DBS troubleshooting evaluation.
Frequently Asked Questions About Choosing a DBS Center
Is the DBS device brand the most important decision?
No. Patient selection, precise lead placement, and expert programming drive outcomes far more than which manufacturer’s device you receive.
What should I look for in a DBS center?
Look for a multidisciplinary candidacy evaluation, deliberate pre-surgical planning, and a team that programs devices regularly and will keep refining yours over the long term.
Is “awake” or “asleep” DBS better?
Both can succeed in experienced hands. Awake surgery with microelectrode recording adds real-time physiological confirmation of placement; the right choice depends on your case, not on what is fastest for a busy operating room.
Can I switch to Neurology Solutions if my device was implanted elsewhere?
Yes. We provide troubleshooting and second-opinion evaluations and can adjust or optimize an existing device.
Do you offer remote DBS programming?
Yes. Secure telemedicine programming lets us optimize your device without every visit needing to be in person.
Which conditions can DBS treat?
Primarily Parkinson’s disease, essential tremor, and dystonia.
Which brain target is right for me — STN, GPi, or VIM?
It depends on your diagnosis and symptoms: STN and GPi are common Parkinson’s targets (GPi is often chosen when dyskinesias or cognitive concerns are prominent), while VIM is typically used for tremor. We’ll recommend the best fit for your specific case.
Your Brain — and Your Future — Deserve This Level of Attention
DBS can be life-changing for the better, but the center and team you choose matter far more than the brand name on the pulse generator. If you are exploring DBS, we invite you to request an evaluation. We will review your story, your imaging, and your records, and partner with you on a plan grounded in selection, precision placement, and expert programming.
Dr. Rob Izor, MD, is a board-certified neurologist and director of Neurology Solutions Consultants PA in Austin, Texas, specializing in movement disorders and integrative approaches to care.