What Are the Risks and Side Effects of DBS Surgery?
Understanding the three types of DBS risk
When discussing DBS, it is helpful to separate potential problems into three categories:
Risks related to brain and device implantation surgery
Problems involving the implanted hardware
Side effects caused by electrical stimulation
These categories differ in how often they occur and how they are managed. An individual patient’s risk also depends on age, general health, medication use, cognitive condition and the planned surgical technique.
Surgical risks
Bleeding in the brain
DBS electrodes are inserted through small openings in the skull and guided toward a precisely selected target. Because the electrode passes through brain tissue, intracranial bleeding is a recognised but uncommon complication.
A small haemorrhage may cause no lasting symptoms. A clinically significant haemorrhage can cause weakness, speech difficulty, confusion, stroke-like symptoms or, very rarely, a life-threatening complication.
Careful trajectory planning, blood-pressure control and appropriate management of anticoagulant or antiplatelet medication are important parts of risk reduction.
Infection
Infection can develop around the scalp incision, the connecting cable or the implanted pulse generator in the chest.
Some superficial infections may respond to antibiotics. A deeper infection can require removal of part or all of the DBS system, followed by reimplantation after the infection has resolved.
Patients should contact their treatment team if they develop increasing redness, swelling, discharge, fever or worsening pain around an incision.
Seizure and neurological injury
A seizure can occur after DBS surgery, although it is uncommon. Neurological problems may also result from bleeding, swelling or direct injury along the electrode trajectory.
The risk cannot be reduced to zero, but modern imaging, accurate planning and careful surgical technique are intended to avoid blood vessels and critical brain structures.
Anaesthesia-related complications
Depending on the surgical method, DBS may be performed partly awake, under sedation or under general anaesthesia. Anaesthetic risks can include breathing problems, cardiovascular complications, nausea and adverse medication reactions.
The safest approach is selected according to the patient’s health, symptoms and the experience of the DBS team.
Device-related complications
DBS is an implanted electronic system consisting of electrodes, connecting wires and a pulse generator. Possible hardware problems include:
Movement or incorrect positioning of an electrode
Fracture or disconnection of a lead
Skin erosion over part of the system
Discomfort around the extension wire or battery
Battery depletion
Device malfunction
Some problems can be managed through programming, while others may require a surgical revision or replacement of a component.
Rechargeable and non-rechargeable pulse generators have different maintenance requirements. Patients should understand how their particular system is checked, charged or replaced.
Stimulation-related side effects
Electrical stimulation can sometimes affect nearby neural pathways as well as the intended target. Possible stimulation-related side effects include:
Tingling or unusual sensations
Muscle pulling or tightness
Slurred or reduced-volume speech
Balance or walking difficulty
Double vision or other visual symptoms
Dizziness
Involuntary movements
Mood or behavioural changes
An important feature of DBS is that many of these effects are adjustable. Changing the stimulation contact, intensity, pulse width or frequency may reduce a side effect while preserving clinical benefit.
Programming is therefore not a single appointment. Several sessions may be required to find the most suitable balance between symptom control and adverse effects.
Can DBS affect speech, balance or cognition?
Speech and balance symptoms require particular care. Parkinson’s-related speech, freezing and postural instability may respond less predictably to DBS than tremor, rigidity and levodopa-responsive slowness.
In some patients, stimulation can worsen speech or balance. Adjustment of the settings may help, but symptoms caused mainly by disease progression may not be reversible through programming.
Significant cognitive impairment or uncontrolled psychiatric illness can also affect DBS suitability. This is why cognitive and psychological assessment may form part of the preoperative evaluation.
For a clearer explanation of expected symptom response, see Which Parkinson’s Symptoms Respond Best to DBS?.
Does DBS stop Parkinson’s disease from progressing?
No. DBS is a symptomatic treatment. It can reduce selected motor symptoms and motor fluctuations, but it does not cure Parkinson’s disease or stop its underlying progression.
Symptoms that do not respond well to levodopa—particularly certain balance, speech, swallowing and cognitive problems—may continue to progress despite good control of tremor or rigidity.
How are DBS risks reduced?
Risk reduction begins before surgery and continues throughout follow-up. It may include:
Multidisciplinary patient selection
Detailed MRI- or CT-based trajectory planning
Review of anticoagulant and antiplatelet medication
Blood-pressure and infection-risk management
Cognitive and psychiatric assessment
Accurate electrode placement
Careful wound follow-up
Individualised postoperative programming
During consultations, I discuss not only whether DBS can improve a patient’s symptoms, but also whether the expected functional benefit is large enough to justify the individual risks and long-term follow-up requirements.
When should a patient seek urgent medical advice?
Patients should seek prompt medical assessment for:
Sudden weakness, speech difficulty or reduced consciousness
A new severe headache
A seizure
Fever or discharge from an incision
Increasing redness or swelling over the implanted system
Sudden loss of stimulation benefit
Unexpected severe changes in mood or behaviour
Frequently asked questions
Is DBS considered a safe operation?
DBS is generally considered safe when performed in appropriately selected patients by an experienced team. Nevertheless, it is brain surgery and potentially serious complications can occur.
Are DBS side effects permanent?
Many stimulation-related side effects are reversible and can improve after reprogramming. Complications caused by bleeding, infection or neurological injury may require additional treatment and can occasionally produce lasting effects.
Can the DBS device be removed?
Yes. The system can be partly or completely removed if medically necessary. Removal may be considered for infection, hardware problems or other significant complications.
Will I still need Parkinson’s medication after DBS?
Usually, yes. Medication may be adjusted after surgery, but DBS should not be viewed as a guarantee that medication can be stopped.
Conclusion
DBS has surgical, hardware-related and stimulation-related risks. Serious complications are uncommon, while many stimulation side effects can be managed by careful programming.
The decision should be based on an individual comparison between the symptoms likely to improve, the patient’s personal risk factors and the long-term responsibilities of living with an implanted DBS system.
Kaan Tugberk Ozdemir, MDNeurosurgeon – Izmir, Türkiye
This article provides general information and does not replace an individual medical assessment, diagnosis or treatment recommendation.
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