Sept. 15, 2026
Mayo Clinic is a pioneer in the field of deep brain stimulation (DBS) for the treatment of movement disorders. Richard B. Dewey III, M.D., a movement disorders neurologist at Mayo Clinic in Jacksonville, Florida, answers frequently asked questions about referring patients for DBS.
Which movement disorders might be treated with DBS?
Our neurologists and neurosurgeons have deep experience providing DBS for patients with dystonia, essential tremor and Parkinson's disease.
How might DBS benefit patients with movement disorders?
DBS is very effective at managing tremor as well as stiffness and slowness of movement. The procedure is very well tolerated, and our center has decades of experience making it a safe option.
Once DBS is in place, a patient's medications might be simplified dramatically as relates to frequency and timing. Medications are also expected to work better and last longer in certain patients. DBS can also be a treatment for movement disorders where medications have been tried unsuccessfully. In carefully selected patients, this therapy can provide results that medications haven't.
When should patients with movement disorders be referred to a specialist center for DBS?
For Parkinson's disease, there are a lot of criteria and little "tricks," including the 5-2-1 rule: Referral should happen when patients take levodopa pills at least five times a day and experience at least two hours of symptoms and at least one hour of troublesome dyskinesia a day.
But it's important for patients and clinicians to think about DBS before the procedure is absolutely needed, as the pill burden quickly can become excessive. Many different medications are available to treat the motor symptoms of Parkinson's disease. No patient needs to try all of them.
The same guidance of early referral applies to other movement disorders. There's no hard cutoff age when patients won't be considered for surgery. But the longer you wait, the higher the complication rate. Earlier implantation yields smoother surgery, as patients may have fewer medical comorbidities.
We don't want to regret a lost opportunity for surgery. We can always evaluate a patient early and decide to continue a nonsurgical approach for now. But it's tough to go back in time if you wait too long.
How is eligibility for DBS determined?
At Mayo Clinic, patients considering DBS undergo thorough assessments, including balance and neuropsychological testing. We want to make sure patients aren't at risk from the surgery in terms of cognition or speech. We also make sure that medications are optimized beforehand to allow the best chance of success from surgery.
DBS involves a high level of collaboration between our neurologists and neurosurgeons. Our neuropsychologists and physical and occupational therapists are also involved in assessing candidates for DBS.
What technology is used for DBS placement?
Mayo Clinic offers advanced surgical technology, including computer-assisted surgery, intraoperative MRI and awake brain surgery.
How can DBS provide personalized treatment?
Like many neurological conditions, movement disorders aren't one-size-fits-all. At Mayo Clinic, we're committed to carefully evaluating patients and integrating individualized treatments. Patients with movement disorders might be undergoing verified treatments but missing out on newer, more-nuanced approaches personalized to them. That's what we hope to provide.
For more information
Refer a patient to Mayo Clinic.