Dr. Pedro Roldán Ramos
Neurosurgeon · Functional surgery, DBS and HIFU · Professor at the UB
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Neuromodulation
DBS for essential tremor, dystonia and refractory epilepsy
Deep brain stimulation when medication no longer controls essential tremor, dystonia or epileptic seizures. Reversible, adjustable, and it does not destroy tissue. If your case is Parkinson's disease, the specific page is DBS for Parkinson's.
Definition
What is deep brain stimulation (DBS)?
DBS implants thin electrodes in specific brain structures connected to a subcutaneous generator. The electrical impulses modulate neural circuits to correct their malfunction, reducing symptoms without destroying tissue.
"Deep brain stimulation is the reference treatment for refractory essential tremor, generalised dystonia and Parkinson's disease with fluctuating response to levodopa."
Indications and target by condition
- Essential tremor refractory to propranolol and primidone, when the tremor makes eating, writing or working difficult. Usual target: VIM nucleus of the thalamus. Incisionless alternative: HIFU, which treats one side per session and is not programmable.
- Dystonia: generalised, segmental or cervical, including genetic forms. Usual target: globus pallidus internus (GPi). Improvement is gradual and may take months to settle.
- Refractory epilepsy in patients who are not candidates for resective surgery, after assessment in an epilepsy unit. Usual target: anterior nucleus of the thalamus (ANT).
- Parkinson's disease with motor fluctuations and dyskinesias. This is the highest-volume indication and has its own page, with a real patient case on video and medication-reduction figures: DBS for Parkinson's.
DBS or HIFU: DBS is reversible and programmable, can treat both sides and covers tremor, dystonia and epilepsy. HIFU implants nothing and is done in a single session, but it creates a permanent lesion and its main indication is tremor. The choice is made case by case at the multidisciplinary board.
Additional information for patients: manufacturer leaflets on DBS therapy on the Boston Scientific portal: estimulacion-cerebral-profunda.es. This link is informational and does not imply commercial endorsement.
How it is done
Step by step of DBS implantation
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1 · Multidisciplinary assessment
Joint evaluation with neurology. In tremor and dystonia, specific motor scales are applied (TETRAS, BFMDRS), and in epilepsy the work-up from the epilepsy unit is reviewed. Prior neuropsychological and psychiatric assessment in all cases.
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2 · Stereotactic planning
High-resolution brain MRI fused with CT on the day of surgery. Millimetric calculation of the target (VIM for tremor, GPi for dystonia, ANT for epilepsy, STN in Parkinson's) and the trajectory to avoid blood vessels.
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3 · Electrode implantation
Electrode placement under stereotactic guidance (frame or frameless). Intraoperative neuronal microrecording to confirm the correct target. Clinical test with the awake patient to verify improvement and rule out adverse effects.
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4 · Generator (IPG) implantation
In the same operation or 2-4 weeks later: placement of the pulse generator below the clavicle with a subcutaneously tunnelled cable from the scalp.
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5 · Initial programming
Activation and progressive programming in clinic 2-4 weeks after implantation. Periodic parameter adjustments (amplitude, frequency, pulse width, active contact) during the first 6-12 months.
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6 · Coordinated follow-up
Joint reviews with neurology. Stimulation adjustments and the gradual reduction of medication are planned as a team. The generator battery is checked at every visit and replaced when it runs out, without touching the electrodes.
Video · short explanations
Deep brain stimulation explained by Dr. Pedro Roldán
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. Gabriel Salazar Tortolero
Neurologist · Parkinson's disease, tremor and movement disorders
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Locations
Where we treat deep brain stimulation (DBS)
Surgical procedures are carried out in operating theatres equipped with the technology required for deep brain stimulation (DBS). 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."
Frequently asked questions about DBS
Is DBS used for essential tremor and not only for Parkinson's?
Yes. In essential tremor refractory to medication the usual target is the VIM nucleus of the thalamus, and the improvement in tremor can already be seen in the operating room during the clinical test. Unlike HIFU, DBS can treat both sides and the stimulation can be adjusted over time.
What results can be expected from DBS in dystonia?
In dystonia the response is gradual: unlike tremor, the improvement is not immediate and settles over weeks or months of programming. The usual target is the globus pallidus internus (GPi), and generalised dystonias of genetic origin are the ones that respond best.
When is DBS considered for refractory epilepsy?
When seizures are not controlled with drugs and the patient is not a candidate for resective surgery, after assessment in an epilepsy unit. Stimulation of the anterior nucleus of the thalamus reduces seizure frequency in selected cases, but it is not a curative treatment.
Is DBS or HIFU better?
It depends on the condition and the case. DBS is reversible, programmable and can treat both sides; HIFU avoids incisions and implants and is done in one session, but it creates a permanent lesion and treats one side per session. The decision is made by the board together with neurology.
Request information
Are you a candidate for DBS?
Send us your reports and we will review your case in a multidisciplinary committee (neurology + functional neurosurgery), including whether DBS or HIFU suits you better.