Deep brain stimulation places thin electrodes in a specific target inside the brain, usually the subthalamic nucleus or globus pallidus, connected under the skin to a pulse generator in the chest. Continuous stimulation smooths out the motor fluctuations that medication alone can no longer control. It treats symptoms; it does not slow the disease.
Deep brain stimulation places thin electrodes in a specific target inside the brain, usually the subthalamic nucleus or globus pallidus, connected under the skin to a pulse generator in the chest. Continuous stimulation smooths out the motor fluctuations that medication alone can no longer control. It treats symptoms; it does not slow the disease.
The people who do best have Parkinson's disease that still responds well to levodopa but whose good hours have become unpredictable, or who have troublesome involuntary movements at peak dose. The rule that surprises patients is this: with the exception of tremor, stimulation does not fix symptoms that never responded to levodopa. Balance problems, freezing that persists in the on state, speech changes and cognitive symptoms generally do not improve, and some can worsen. Significant dementia and unstable psychiatric illness usually rule it out.
This practice performs no surgery. Implantation is done by a functional neurosurgeon at a hospital, working with the centre's neurology team, and the device is programmed at that centre over months of visits. The role of the neurologist here is the part that comes before and after: establishing that the diagnosis is right, testing the levodopa response, judging whether the symptoms causing trouble are ones stimulation actually helps, making the referral, and managing medication for the years that follow.
Programming is iterative. Settings are adjusted across repeated visits and medication is usually reduced as stimulation takes over, which is one of the real benefits and also a period that needs close supervision. Speech changes, tingling and mood shifts can appear at particular settings and often resolve when the settings change. Anyone expecting a single switch-on appointment finds this frustrating, so it is worth knowing in advance.
Focused ultrasound and older lesioning procedures address tremor without an implanted device but are typically one-sided and not adjustable afterwards. Levodopa-carbidopa intestinal gel and apomorphine infusion address fluctuations by a different route. Which of these fits depends on the dominant symptom and on other medical conditions, and it is a conversation to have before a referral is made rather than after.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: Parkinson's disease; National Institute of Neurological Disorders and Stroke; American Academy of Neurology.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.