A recently published paper by a panel of 30 international experts goes on record to challenge some long-standing misconceptions about when Deep Brain Stimulation should be considered for patients and who exactly is eligible for the procedure. While medical experts agree that the surgery isn’t for everyone, the percentage of patients getting the surgery remains very low. The authors argue this gap is driven less by a lack of evidence and more by hesitation, outdated referral practices, and persistent fear surrounding brain surgery.
Deep Brain Stimulation, or DBS, is a procedure in which electrodes are placed in the brain that send electrical signals to help correct and normalize abnormal brain activity. In turn, these corrective signals help reduce symptoms like tremors, gait and balance issues, and stiffness in patients with Parkinson’s and Essential Tremor. The modulated signals allow individuals to experience a more “normal” lifestyle than medications designed to ease symptoms can provide. Recent advancements with Advanced Deep Brain Stimulation (aDBS) have taken DBS a few steps further by allowing real-time stimulation adjustments to be made, allowing for a more customizable solution and providing an even better quality of life for the individual.
The panel highlighted concerns around the term “advanced” when defining Parkinson’s for patients, because of the inconsistency of what the label actually means in clinical practice, research settings, and lived experience. The result can be delayed care, missed referrals, and patients ultimately losing the window in which they may qualify for surgery. The authors make the point that DBS referrals should not be delayed by waiting for medical options to be exhausted or until symptoms reach such a high severity.
“Referrals for surgical evaluation should occur alongside ongoing medication adjustments, particularly when those changes fail to adequately control motor symptoms regardless of the stage of disease progression.”
According to a study published in Parkinsonism and Related Disorders, 22% of Medicare beneficiaries with Parkinson’s have an advanced version of the disease, but “as few as 2% of potentially eligible patients receive this therapy.” Experts blame systemic hesitation and misinformation about DBS itself, not a lack of evidence.
“While factors such as distance from a treatment center and social drivers of health may influence access, others such as physician or patient knowledge and familiarity, as well as misperceptions regarding the procedure, treatment process, expectations, and using ‘cut-offs’ for disease stage and levodopa improvement that are not data-driven, may also influence timely referrals and evaluations.”
They also conclude that differences in how neurologists evaluate candidacy for DBS are “variable,” citing a lack of standardized, evidence-aligned referral behavior and inconsistency.
The panel concluded that an evaluation for DBS should be considered when there is the “presence of troublesome motor fluctuations and/or dyskinesia that interferes with functioning or quality of life despite optimal medical management, presence of disabling tremor that is refractory to an adequate levodopa trial, and intolerance of even low-dose maintenance levodopa therapy due to side effects, in the presence of objective levodopa response.” They also point out that “referral for DBS evaluation should not be viewed as a last resort,” citing that “stigma, fear and misconceptions about neurosurgical interventions can significantly impact patients’ willingness to explore potentially life-changing interventions.”
For patients, there can be a lot of apprehension about going through with the procedure because of what is involved. The idea of having metal rods placed into the brain and a battery embedded in the upper chest can feel extreme, often reinforcing fear, stigma, and hesitation, even when the therapy is well supported by evidence. Estimates suggest that more than 244,000 people worldwide have received deep-brain stimulation implants since the therapy was introduced in the late 1980s. In the United States alone, hospital data indicate that several thousand DBS procedures are performed each year, historically around 5,500 annually, primarily for movement disorders, according to data from Wikipedia and the NIH.
There have been many success stories of those lives changed by DBS, in an article from Parkinson’s Europe, individuals like Ivan O’Regan, a Parkinson’s patient from Ireland, have “never looked back” after having the procedure in February of 2022, stating, “If I hadn’t had DBS,” he says, “I don’t know what we would have done. It’s like night and day.” In November of 2025, The Washington Post reported that Denise Bacon, a semi-professional clarinetist with Parkinson’s disease, showed immediate mobility improvements during DBS surgery in London, famously playing her clarinet as electrodes were implanted. After surgery, symptoms that once limited walking, eating, and music became far more manageable.
The panel argues that DBS is a proven technology that is underutilized because of outdated thinking, referral habits, and a need for more education. While the researchers admit that establishing a uniform set of guidelines is challenging—Parkinson’s is different for every patient, and there is no one-size-fits-all solution. The paper calls for a more practical, real-world approach to deciding when DBS makes sense for each patient. It also stresses the need to build stronger local networks that connect hospitals with community providers to improve communication, streamline referrals, reduce barriers to care, support shared decision-making, and ultimately expand access to DBS and aDBS, offering life-changing intervention for every eligible patient, not just the small percentage who receive it now.
The entirety of the paper can be read here at Nature Communications.
Curious about how DBS works? Read the breakdown on what’s involved and how the surgery is done here.
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