Parkinson's Disease — Timoteo Almeida, MD, PhD

Parkinson's Disease

When medications alone no longer provide smooth, predictable control of your symptoms, deep brain stimulation can help reduce "off time," ease dyskinesias, and restore consistency to your day.

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Established surgical therapy

DBS is a proven option for PD — especially when medications help but cause motor fluctuations or dyskinesias.

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Robot-assisted precision

Robotic DBS supports accurate electrode placement and streamlined surgical workflows for optimal outcomes.

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Not a cure — but life-changing

DBS does not stop disease progression, but it can meaningfully improve quality of life and reduce "off time."

Understanding your condition

What is Parkinson's disease?

Parkinson's disease is a neurodegenerative condition commonly associated with slowed movement (bradykinesia), stiffness (rigidity), tremor, and walking or balance changes. Medications — especially levodopa — can be very effective, but over time many patients develop wearing-off periods and dyskinesias that become difficult to manage.

When medication adjustments alone are no longer enough to keep symptoms under control throughout the day, surgical options like deep brain stimulation may help bridge the gap.

Am I a candidate?

Who may benefit from DBS?

You may be a candidate if:

A thorough evaluation — including movement-disorder assessment and neuropsychological screening — helps determine whether DBS is right for you.

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You have a confirmed diagnosis of idiopathic Parkinson's disease with symptoms that still respond to levodopa, but you experience disabling medication side effects or fluctuations.
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Your motor symptoms significantly affect daily life despite optimized medication management.
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You have no uncontrolled medical issues that would make surgery unsafe, and no severe, unmanaged cognitive or psychiatric illness.

Your options

Treatment Options

DBS is the primary surgical approach for Parkinson's disease. Other options exist for select situations, and the best path depends on your individual symptoms, goals, and anatomy.

⚙ Primary option

Robotic DBS

Deep Brain Stimulation with robot-assisted stereotactic guidance

How it works Electrodes are placed in specific motor targets — commonly the subthalamic nucleus (STN) or globus pallidus internus (GPi) — connected to a programmable battery under the skin.

Target selection Individualized based on your symptoms, age, cognition, dyskinesia profile, and personal goals.

Key advantage Adjustable and reversible. Robot-assisted guidance supports precise trajectory alignment. Offered awake or asleep depending on approach.

Adjustable Reversible Bilateral Awake or asleep

◇ Select scenarios

Other Options You May Hear About

Lesioning approaches and foundational therapies

Medication & rehabilitation Medication optimization and rehabilitation remain foundational to PD management and complement any surgical approach.

Lesioning approaches MRI-guided focused ultrasound (MRgFUS) or radiosurgery may be considered in select scenarios, but they are not adjustable like DBS.

Key consideration Lesioning procedures are typically planned carefully around sidedness and symptom goals, and are best suited for specific clinical situations.

Incisionless options Not adjustable Select patients

Your journey

What to Expect

DBS is a process — not a single event. Here's an overview of the typical pathway from evaluation to optimized stimulation.

Before your procedure

Movement-disorder evaluation with medication "on/off" assessment, brain MRI/CT for targeting, and neuropsychological screening. We'll discuss your goals and expectations in detail.

During

The surgical plan can be staged. We offer both "awake" and "asleep" DBS depending on the approach and your needs. Robot-assisted guidance helps ensure precise electrode placement along the planned trajectory.

After

Initial healing period, then programming visits begin to tune stimulation settings. Medications are often adjusted over time as stimulation is optimized. Programming continues over several visits for best results.

Weighing your decision

Benefits and Risks

Potential Benefits

✦ Reduced "off time" — more consistent symptom control throughout the day
✦ Reduced dyskinesia burden
✦ Improved tremor, rigidity, and bradykinesia control
✦ Medication reduction in many patients (varies by target and individual)

Possible Risks

△ Common: Temporary confusion, headache, bruising or swelling near incisions, short-term mood or sleep changes
△ Uncommon: Intracranial bleeding or stroke, infection, seizure, and hardware complications requiring revision

Common questions

Patient FAQs

Will DBS help my balance?

DBS is most reliable for improving tremor, stiffness, slowness, and reducing "off time." If your walking or gait symptoms improve when your Parkinson's medications are working, DBS can often help those medication-responsive "off" gait issues as well.

Can I go through MRI after DBS?

In most cases, yes. Many modern DBS systems are MRI-conditional, meaning MRI can be performed safely when specific guidelines are followed. Our team coordinates the MRI protocol — and adjusts device settings when needed — so you can still access important imaging over the long term.

Will I still take Parkinson's medications?

Often yes. As stimulation is optimized, doses are commonly adjusted and may be reduced, which can lessen wearing-off and dyskinesias. The goal isn't necessarily to stop medications — it's to find the best balance of stimulation and medication for smoother, more predictable control.

Is robotic DBS "better"?

Robotics can support precision and surgical workflow; outcomes still depend on correct diagnosis, target choice, and expert programming. The robot is a tool that enhances what the surgical team does — not a replacement for clinical expertise.

When to Seek Urgent Care

Call your care team right away — or go to the ER (or call 911) — for sudden weakness or numbness, a severe or worsening headache, confusion, seizure, fever, wound redness or drainage, or new trouble walking that is getting worse quickly.