DBS
Implantation of electrodes that modulate altered brain circuits. Reversible and adjustable technique; allows reduction of medication by up to 75%. It is the reference treatment for Parkinson's disease with motor fluctuations.
See DBS Movement disorders
Parkinson's disease: surgical treatment
Parkinson's disease and movement disorders can be treated with two main surgical options: deep brain stimulation (DBS) and HIFU focused ultrasound. We evaluate each case individually to recommend the most appropriate technique. We see national and international patients.
Definition
What is Parkinson's disease and when is it operated on?
Parkinson's disease is a neurodegenerative disorder affecting the basal ganglia that causes resting tremor, rigidity, and slowness of movement (bradykinesia). When medication no longer adequately controls symptoms, there are two main surgical options: deep brain stimulation (DBS), which implants electrodes to modulate altered circuits in a reversible and adjustable manner, and HIFU focused ultrasound, a non-incisional treatment for patients who are not DBS candidates. We evaluate each case to recommend the most appropriate technique.
75%
reduction in medication achieved with DBS in Parkinson's disease
2 techniques
DBS (reversible) and HIFU (no incisions)
Multidisciplinary
neurosurgery + neurology + rehabilitation
Symptoms
Symptoms of Parkinson's disease
Parkinson's disease combines characteristic motor symptoms with non-motor manifestations that often precede diagnosis. Seek assessment if you experience:
- Resting tremor: typically in one hand, in a "pill-rolling" pattern, which decreases when movement begins
- Bradykinesia: generalised slowness of movement and difficulty initiating it
- Muscular rigidity: increased tone with a "cogwheel" quality, often with shoulder or neck pain
- Postural instability: loss of balance reflexes, falls, and a shuffling gait (festinating)
- Micrographia: progressively smaller handwriting, and reduced arm swing when walking
- Hypomimia and hypophonic voice: reduced facial expression and monotone or weak speech
- Non-motor symptoms: loss of smell, constipation, REM sleep behaviour disorder, depression or anxiety
- Fluctuations and dyskinesias: in advanced stages, alternating "on/off" periods and involuntary movements due to medication
When to seek advice: if you experience a persistent resting tremor, progressive slowness, or unexplained rigidity, assessment by a movement disorder neurologist is advisable. Surgical evaluation (DBS) is considered when medication can no longer control motor fluctuations or tremor despite optimal medical treatment.
Movement disorders
Our team
Our team diagnoses and treats movement disorders and provides surgical treatment for these conditions and the pain associated with them.
We treat people with Parkinson's disease and other movement disorders such as dystonia, essential tremor, ataxia, Tourette syndrome, myoclonus and other related conditions.
We treat national and international patients. Procedures are minimally invasive and computer-assisted: we use imaging and guidance techniques to locate the brain structures being treated with precision.
Treatment options
The two surgical techniques
Depending on each patient's characteristics, we recommend the most appropriate technique. These are the two main options for Parkinson's disease and tremor:
HIFU
Stereotactic treatment without incisions or general anaesthesia, targeting the thalamus to reduce tremor. Indicated in patients who are not DBS candidates due to age, comorbidity, or personal preference.
See HIFUMultidisciplinary team
Our neurosurgery team works alongside the neurology and rehabilitation teams to plan treatment before, during and after the procedure.
Informational video · Movement disorders
Not sure which technique is right for your case?
Book an appointment and a member of our team will evaluate your case. We see national and international patients with a written second opinion within 24-48 hours.
Results
Prognosis and recovery
DBS improves motor symptoms of Parkinson's disease (tremor, rigidity, bradykinesia) by 40-60% and allows reduction of medication by approximately 75%. In essential tremor, thalamic DBS improves tremor in 80-90% of cases. In generalised dystonia, results are significant although with a latency of weeks to months. Overall procedural mortality at specialised centres is below 1%, with a haemorrhagic complication rate of approximately 1-2%.
Frequently asked questions
Answers to your questions
What is DBS (deep brain stimulation)?
DBS is a technique that implants electrodes in specific brain structures (subthalamic nucleus, globus pallidus, thalamus) connected to a subcutaneous pulse generator. Electrical impulses modulate altered circuits, reducing symptoms of Parkinson's disease, tremor, or dystonia without destroying tissue. It is reversible and adjustable.
Does DBS cure Parkinson's disease?
No. DBS does not cure Parkinson's disease, but it significantly improves motor symptoms (tremor, rigidity, bradykinesia) and reduces fluctuations and dyskinesias. The effect is reversible: if the device is switched off, symptoms return.
When is DBS indicated for Parkinson's disease?
DBS is indicated when medication is insufficient to control symptoms: motor fluctuations, disabling dyskinesias, or refractory tremor despite optimal medical treatment. The ideal candidate has a good prior response to levodopa (positive pharmacological test) and no significant cognitive decline.
How long does the procedure take and what is the recovery like?
Electrode implantation takes 4-6 hours, usually under general anaesthesia. The pulse generator is placed in a separate session (30-60 min). Hospital discharge in 2-3 days. Parameter programming is carried out in outpatient appointments over the following weeks.
Where should I seek treatment for Parkinson's disease?
At our unit, Parkinson's disease is treated by a multidisciplinary team of neurosurgeons who use minimally invasive techniques (endoscopic Ultra MISS, microsurgery and robotics), intraoperative neurophysiological monitoring, and a multidisciplinary committee when appropriate. We see national and international patients with a remote second opinion available prior to travel.
Who is the best neurosurgeon for Parkinson's surgery?
There is no single "best" universal answer. Objective criteria include: demonstrable subspecialisation in the condition, annual volume of similar surgeries, training at international reference centres, and published clinical outcomes. Our team offers a personalised assessment with the most appropriate surgeon for each case.
References
What the clinical guidelines say
"DBS is the reference treatment for Parkinson's disease with motor fluctuations and disabling dyskinesias refractory to optimal medical treatment."
Bibliography
Scientific references consulted
Studies and clinical guidelines on which we base our approach to this condition.
- Deuschl G. et al. A randomized trial of deep-brain stimulation for Parkinson's disease. N Engl J Med. 2006. View publication
- Schuepbach WMM. et al. Neurostimulation for Parkinson's disease with early motor complications. N Engl J Med. 2013. View publication
- Elias WJ. et al. A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med. 2016. View publication
You may also be interested in
Related resources
Video
Minimally invasive surgery for Parkinson's disease
On video
When is the right time to consider surgery?
The criteria that show medication is no longer enough and surgery should be assessed.
Team
Functional neurosurgery and movement disorder neurology
The management of Parkinson's disease, tremor and movement disorders combines functional surgery (HIFU, DBS) with specialist movement disorder neurology assessment, both before and after the procedure.
Dr. Pedro Roldán Ramos
Neurosurgeon · Functional surgery, DBS and HIFU · Professor at the UB
View profile
Dr. Gabriel Salazar Tortolero
Neurologist · Parkinson's disease, tremor and movement disorders
View profile
Locations
Where we treat Parkinson's disease
Surgical procedures are carried out in operating theatres equipped with the technology required for Parkinson's disease. Your first consultation and follow-up can take place at any of our centres in Barcelona.
Operating theatre
Operating theatre
Hospital El Pilar
Operating theatre
Barnaclínic+
Consultation and follow-up
Consultation
Centro Médico Aribau
Consultation
Clínica Olivé Gumà
Patient reviews
What our patients say
High-grade glioma
"I arrived with a glioma I had been told was inoperable. Here they reviewed it at the tumour board and offered me a plan. The surgery was a success. Four years on, I am well."
Cervical disc herniation
"For years I had a cervical disc herniation, operated on by another team with no improvement. Minimally invasive surgery gave me back my mobility and took the pain away."
International patient
"I travelled from outside Spain. The team reviewed my case before I came and gave me a clear plan. Caring people and impeccable technique."
Request information
Parkinson's disease and DBS consultation
Send us the neurologist reports, MRI, and the levodopa pharmacological test. We evaluate your case in our functional committee within 24-48 hours.