Deep Brain Stimulation Surgery

Meet Our Specialists

Norton Neuroscience Institute is a leading center for deep brain stimulation surgery in Louisville and Southern Indiana. The minimally invasive procedure can relieve the symptoms of epilepsy and movement disorders such as Parkinson’s disease, essential tremor and dystonia.

If you have one of these conditions, typically you’ll manage bothersome symptoms with medication. As the disease progresses you may develop bothersome or disabling movements and side effects that don’t respond as well to medication. For movement disorders these symptoms can include tremors, changes in your ability to move, slow movements, rigid muscles or involuntary, excessive movements called dyskinesias.

Deep brain stimulation, or DBS for short, can reduce symptoms such as tremor of the hands, slow movements (bradykinesia) and rigid muscles caused by Parkinson’s disease, essential tremor and dystonia. DBS does not slow the progression of movement disorders and isn’t a cure. DBS surgery can improve quality of life.

If you have epilepsy, DBS surgery may help. The procedure does not cure epilepsy. It helps manage your seizures without impacting other parts of their brain.

DBS surgery is a minimally invasive procedure. Your neurosurgeon accesses your brain through one or more small holes in your skull. You won’t need to shave your head.

With highly specialized tools, your neurosurgeon places small wires inside your brain that are connected to a device implanted in your chest. The device sends impulses to the brain that provide electrical stimulation that interrupts nerve signals that cause symptoms such as tremors, rigidity and stiffness. 

Deep brain stimulation can improve motor symptoms, which affect your ability to move, by up 50% in many cases. Sometimes, patients see symptoms improve by 80% or more. 

Our board-certified and fellowship-trained neurosurgeons have extensive experience with deep brain stimulation and are at the forefront of new techniques that provide greater safety and better outcomes.

1st in Louisville Area to Perform Asleep DBS Routinely

Historically, DBS surgery has been performed while the patient is awake. The patient would remain conscious to respond or perform simple tasks to help the neurosurgeon correctly place each electrode.

Being awake during brain surgery rightly made many patients anxious and required they skip their medication on the day of the surgery. Being awake during surgery also increases surgical risks.

Abigail J. Rao, M.D., neurosurgeon with Norton Neuroscience Institute, was the first in the Louisville area to use advanced techniques that allow the patient to be unconscious during DBS surgery.

If you are considering DBS surgery, you’ll be evaluated by our multidisciplinary team, which includes movement disorder neurologists, functional neurosurgeons and neuropsychologists, as well as physical therapists, occupational therapists and speech therapists.

At our monthly conference, the team of medical providers in the deep brain stimulation program reviews your medical records and other data. With their specific areas of expertise and experience with DBS devices, team members discuss each patient and make recommendations. Having multiple physicians bring their viewpoints is like getting multiple opinions at once.

The same team cares for you before, during and after the surgery. We have a patient navigator dedicated to DBS patients to help coordinate care and support you during the process. Our care team has specialized training and experience to provide a precise diagnosis of your condition and lay out a treatment plan customized for you.

Conditions We Treat With Deep Brain Stimulation

What to Expect: Deep Brain Stimulation Evaluation, Surgery and Follow-up

If you are a candidate for deep brain stimulation, you’ll go through six steps.

Meet with a neurologist, neurosurgeon or both

You’ll meet with a movement disorder specialist to determine whether you could be a candidate for DBS. Your first appointment may be with a neurologist or neurosurgeon, depending on your situation.

During your first appointment, the doctor will review your complete medical history and perform a neurological examination to determine your eligibility for DBS.

Meet With the DBS Team

In this step, you have a few appointments with different members of the DBS team. The DBS patient navigator will help make, coordinate and explain these appointments. The visits are:

  • Physical therapy and occupational therapy: During these appointments, therapists who specialize in movement disorders will evaluate your fine motor movements, , stiffness, walking and balance. They will record video of your movement examination during two time periods (for a patient with Parkinson’s disease): when your medications are in effect, and when you have withheld medications for a few hours.
  • Neuropsychology: This appointment evaluates your memory and thinking. We recommend you bring a caregiver or family member to this appointment.
  • Speech therapy: A speech therapist will evaluate your speech and swallowing function.

Meet With Your Neurosurgeon

You will meet with our neurosurgeon to talk about the details of surgery and ask any questions you may have. We will discuss what to expect after surgery, the risks of surgery, expected recovery experience and goals of surgery.

Pre-surgery appointments: These appointments take place if, after the steps above, you and your medical team decide to proceed with surgery. They are:

  • MRI – This is a specialized scan with a 3 tesla (3T) MRI unit. The images allow your surgeon to plan where to place the electrodes during surgery. Your pre-surgery MRI usually is done without sedation. If you need medication to help you relax during the MRI, or if you can’t help but move during the MRI, making the images unclear, we will arrange for sedation.
  • Pre-anesthesia testing – You will have a general physical examination to make sure you are healthy enough for surgery and anesthesia.


Surgery occurs in two stages. The first stage places the electrodes in your brain under general anesthesia at Norton Brownsboro Hospital. Your surgeon takes a high-resolution CT scan before surgery starts, to match with high-resolution MRI images that were captured previously. This scan gives Dr. Rao additional information on placing each electrode correctly.

After reviewing your scans in the operating room, the surgeon makes two small incisions, places the electrodes and uses intraoperative CT scan to ensure the electrodes are in the correct place before leaving the operating room. Then you typically would spend one night in intensive care before being discharged, often the next day.

Stage 2 of the DBS procedure happens three to 14 days after the electrodes are placed. At Norton Brownsboro Hospital and under general anesthesia, your surgeon puts the internal pulse generator, also called the IPG or stimulator, under the skin, usually just below the collarbone. Typically, you would leave the hospital before the end of the day.

Programming Your Stimulator

Your stimulator is programmed in the neurologist’s office about two weeks after Stage 2. The neurologists will test your movements carefully during this initial programming. Programming is noninvasive and painless, and is done with wireless technology. The initial programming session takes about one hour, and typically a few programming sessions over the next few months are needed before you get the best symptom control from DBS.

You will get your own programming device that will allow you to check the status of your stimulator, turn off the stimulator, and in some cases, make your own adjustments within safety guidelines established by your neurologist.

Care That’s Focused on You

It’s part of Norton Neuroscience Institute’s goal to care for the whole person, not just the condition.

  • Dedicated patient navigators can help schedule follow-up appointments, coordinate prescription assistance, create customized diet plans and provide guidance on disability benefits, housing, financial and employment concerns, and more.
  • Patients can access support groups, exercise classes and other educational events to connect with others and learn how to make the most of life while managing a neurologic condition.
  • Access an on-demand video library of educational content across a variety of condition-related topics is available.
  • We want to help prevent illness. Get help quitting smoking, and learn the signs of stroke.

A Louisville Leader in Neurological Care

More patients from Louisville and Southern Indiana seek their neurology and neurosurgery care from Norton Neuroscience Institute’s nationally recognized specialists than any other providers in the area.

Your Norton Neuroscience Institute medical provider has the expertise, experience, diagnostic tools and sophisticated treatments to provide care tailored to your needs.

  • More than 130 medical, surgical and research specialists are dedicated to providing innovative care to those with brain, spine and nervous system conditions.
  • Advanced, minimally invasive neurosurgery equipment can speed your recovery and minimize pain.
  • Multidisciplinary clinics provide easy access to care in one convenient appointment for your neurologic condition, with specialists in oncology, cardiology, orthopedics and behavioral health.
  • Norton Healthcare’s four adult-service hospitals in Louisville are certified by DNV, recognizing excellence and expertise in stroke care.
    • Norton Brownsboro Hospital is recognized as a Comprehensive Stroke Center.
    • Norton Audubon Hospital and Norton Hospital are Primary Stroke Centers.
    • Norton Women’s & Children’s Hospital is an Acute Stroke Ready Hospital.
  • Norton Neuroscience Institute is at the forefront of neuroscientific research. As investigators on numerous trials, our physicians contribute to groundbreaking studies and publications in peer-reviewed journals. Also, patients may be eligible to take part in these experimental treatments.
    Learn more about current neuroscience clinical trials and studies.
  • The American Heart Association Get With the Guidelines stroke care program has recognized all four of Norton Healthcare’s adult service-hospitals in Louisville for exceeding national averages in getting patients in the door and administering lifesaving treatment to restore blood flow to the brain.
  • Norton Neuroscience Institute’s multiple sclerosis (MS) program has been designated a Center for Comprehensive MS Care by the National Multiple Sclerosis Society.
  • The National Association of Epilepsy Centers has recognized Norton Neuroscience Institute Comprehensive Epilepsy Center as a level 4 center, providing the highest level of medical and surgical evaluation and treatment for patients with complex epilepsy.
  • Norton Hospital’s neurosurgical intensive care unit is recognized with a silver-level Beacon Award for Excellence by the American Association of Critical-Care Nurses.
  • Norton Neuroscience Institute Resource Center navigators help educate patients and their families about new diagnoses, available treatments and ways to manage their disease.
  • Communicate with your provider, manage appointments, refill prescriptions, get an alert if an earlier appointment becomes available, and more anytime from a computer or mobile device with a free Norton MyChart account.

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