February 16, 2026

@michaelokun

Should we ever turn off or let the deep brain stimulation (DBS) battery expire in late-stage Parkinson’s disease? Spoiler alert: In most cases NO. Deep brain stimulation or DBS is a surgical therapy that delivers electrical pulses to specific brain targets to improve the motor symptoms. Pietro Antenucci and colleagues describe in a new paper in Movement Disorders Clinical Practice how to think about risk-benefit considerations when discontinuing DBS in late stage Parkinson’s disease. Key Points: – In a cohort of late stage Parkinson’s disease patients, a select group were able to discontinue DBS and remain stable on best medical therapy alone for at least 1 year. – Longer duration of prior DBS therapy was associated w/ a lower likelihood of needing rescue device aided therapy after discontinuation, w/ a suggested cutoff around 10.5 years. – Most individuals who required reactivation or additional therapy did so within 3 months of stopping stimulation, frequently due to subacute worsening of akinetic rigid symptoms or complex motor and non-motor issues. My take: This is a nuanced and important discussion. I think you need to be careful with the data in this paper. DBS is very powerful at enhancing medication on time, reducing rigidity, suppressing tremor, controlling dyskinesia and reducing both motor and non-motor fluctuations. In our practice when folks let the battery run out on purpose thinking they do not require DBS anymore, it can lead to some serious symptom rebound and sometimes even urgent surgery. The authors make a great point that later-stage Parkinson’s disease is frequently dominated by axial symptoms, cognitive changes and non-motor burden that may not be fully responsive to DBS. The decision to discontinue stimulation should not be automatic at battery depletion. A multi-dimensional assessment including motor response, falls burden, cognition, caregiver needs and goals of care is essential. Even if you decide to let the battery expire, we recommend leaving the devices in place in case you need them in the future. #michaelokun #parkinson #fixelinstitute