Your DBS Surgery Did Not Give You the Results You Expected. We Understand — and We Can Help.

If you are reading this, you or someone you love has been through Deep Brain Stimulation surgery and the outcome has not been what you hoped for. You may be living with symptoms that have not improved, or that improved initially and have since returned. You may have been through multiple programming sessions with little change. You may have been told that nothing more can be done.

We want to say this to you directly: in most cases, something more can be done.

Prof. Dr. Paresh K. Doshi and his team at Jaslok Hospital have evaluated more than 300 patients who came to us after DBS surgery performed elsewhere did not deliver the expected benefit. Of these 300+ cases, we replaced the electrodes in only 3 to 4 patients. In the remaining cases — through careful re-evaluation, advanced reprogramming, and multidisciplinary support — we were able to achieve meaningful improvement without further surgery.

To put that in perspective: fewer than 1% of patients who have undergone DBS at Jaslok over 28 years have needed to seek revision care elsewhere. That comparison is not a boast. It is an invitation to come and find out what is possible.

Understanding Why DBS Outcomes Fall Short — It Is Rarely One Reason

After 28 years of performing and evaluating DBS surgery, Prof. Dr. Doshi’s answer to the question of why outcomes sometimes fall short is honest and uncomfortable: the therapy, the surgeon, and in some cases the patient’s expectations, all play a role.

The therapy

Deep Brain Stimulation has been proven effective in Parkinson’s disease with motor fluctuations — this is a bold statement, but it is true and supported by the experience of more than 3,00,000 patients worldwide across different regions and technologies. The therapy itself is not the problem.

The surgeon and the centre

This is the most critical variable. DBS is not a procedure that can be learned from a textbook or delivered at adequate quality by a surgeon who performs it infrequently. The questions you should have been able to ask — and should ask now when considering revision care — are these:

• How many DBS surgeries has this surgeon performed in total, and how many per year?
• Does the centre own its stereotactic equipment, or does it borrow it from the device company?
• Does the centre perform microelectrode recording (MER) during surgery to verify electrode placement?
• Is there a dedicated DBS programming specialist — not just the surgeon — managing follow-up care?
• Does the centre have a multidisciplinary team including a movement disorder neurologist, neuropsychologist, and psychiatrist?

Tall claims of experience on the internet are easy to make and difficult for a patient to verify. What you can do is make a simple calculation: annual surgery volume multiplied by years of practice gives you a rough total. At the current state of DBS in India, only three or four centres perform more than 50 DBS surgeries per year. Most centres are significantly below this.

Patient selection and expectations

The decision to offer DBS must be made with a long-term view of the patient’s disease — not for a short-term outcome that impresses at the three-month review. Several patients who have come to us with disappointing results were initially well-selected but were not given realistic expectations about what DBS can and cannot do, or about how the disease would evolve after surgery. Others were operated before they were truly ready, or for symptoms that were better addressed with medication adjustments first.

Understanding which of these factors contributed to your situation is the starting point of our evaluation.

What Our Evaluation Involves — Starting From the Beginning

When a patient comes to us after an unsatisfactory DBS outcome, we do not start from where the last doctor left off. We start from the beginning.

• Step 1 — Re-understanding the disease: We review the patient’s complete clinical history as though we were about to do the surgery ourselves. We reassess the diagnosis, the disease stage, the medication response, and the cognitive and psychiatric profile. This step is often where we find important information that was either not gathered originally or not acted upon.
• Step 2 — Review of electrode placement: We review all available imaging — MRI, CT, or post-operative scans — to understand precisely where the electrodes are in relation to the intended surgical target. In many cases, a slight displacement that appears minor on imaging has a significant impact on which programming strategies are possible.
• Step 3 — Advanced reprogramming: We do not rely on commercially available automatic programming software as a substitute for clinical judgement. Automated tools are guides — the solution lies in the clinician’s understanding of the interplay between stimulation, symptoms, and side effects. Jaslok has been conducting dedicated research on DBS programming optimisation for four years, and our first publication in this field is expected shortly. The algorithms we have developed in-house allow us to extract meaningful benefit even from leads that are not perfectly placed — without replacing them.
• Step 4 — Device assessment: In some cases, the DBS device itself places limits on what programming can achieve. Certain older or basic devices do not support the advanced stimulation parameters — directional stimulation, multiple independent current control, adaptive DBS — that a more complex programming challenge may require. We advise patients honestly when a device upgrade would make a meaningful difference, and when it would not.
• Step 5 — Multidisciplinary optimisation: Programming alone is rarely the complete answer. Our team — comprising a Movement Disorder Specialist, Psychiatrist, Neuropsychologist, Urologist, and Gastroenterologist — addresses the full spectrum of motor and non-motor symptoms. DBS affects the whole person, and optimising it requires a team that treats the whole person.

This multi-step process typically requires a stay of 4 to 7 days in Mumbai for the initial assessment and programming. Thereafter, most patients require 2 to 3 visits in the first year, and an annual visit to maintain stable programming — a significantly lower visit burden than most centres.