Is DBS safe?
Executive summary
Deep brain stimulation (DBS) is widely regarded by clinicians and device-makers as an effective, generally safe treatment for selected movement and some psychiatric disorders when performed at experienced centers, with serious surgical complications uncommon but real [1] [2] [3]. Safety, however, is conditional: perioperative hemorrhage, infection, and neuropsychiatric side effects occur at measurable rates, and long‑term outcomes depend on patient selection, device management, and the center’s experience [4] [3] [5].
1. What “safe” actually means in DBS: efficacy versus risk tradeoffs
Safety in DBS must be framed as a balance between tangible functional benefits and a spectrum of procedural and stimulation‑related harms; professional sources emphasize that for appropriately selected patients DBS can substantially reduce tremor and motor complications and thereby lower overall morbidity from uncontrolled disease, but it remains brain surgery with attendant risks [1] [2] [6].
2. Short‑term surgical risks: rare but potentially serious complications
Large retrospective series report that intraoperative and perioperative adverse events are uncommon but include vasovagal responses (0.8–2.5%), seizures (around 0.3–1.2% in some series), and intracerebral hemorrhage or intraventricular hemorrhage occurring in fractions of a percent to a few percent, with symptomatic hemorrhage and ischemic infarction producing hemiparesis or decreased consciousness in small subsets of patients [7] [4] [8].
3. Long‑term and stimulation‑related harms: cognitive, psychiatric, hardware, and infection risks
Long‑term follow‑up and systematic reviews document that many patients experience adverse effects over time—retrospective cohorts found dozens to hundreds of reported adverse events across most patients studied—and complications such as infection, device‑related problems, worsening speech or balance, delirium, cognitive decline, and even mortality have been reported in the literature, although rates vary by study and center [5] [3] [8] [6].
4. Factors that reduce risk: selection, center experience, and adjustability
Multiple sources stress that careful candidate screening (excluding severe untreated dementia or psychiatric disease), high‑volume teams, advanced imaging and intraoperative monitoring, and the adjustable nature of stimulation (reprogramming or turning devices off) all materially lower complication rates and allow side effects to be managed—explaining why centers of excellence and device manufacturers highlight two decades of favorable safety data [1] [2] [9] [6].
5. Uncertainties, heterogeneity in reporting, and implicit agendas
Published complication rates vary widely because of differences in patient populations, retrospective designs, and center volumes, and some literature and industry materials emphasize safety and benefit—Boston Scientific and hospital sites cite large experience—potentially downplaying rare but severe outcomes; conversely, retrospective studies and systematic reviews point to nontrivial rates of neuropsychiatric and hardware complications, underscoring heterogeneity and the need to scrutinize study methods when interpreting “safety” claims [1] [5] [3] [8].
6. Bottom line — is DBS safe?
For the right patient, at an experienced, multidisciplinary center, DBS is generally a safe and effective therapy with most serious complications rare and many stimulation side effects reversible through programming, making it an accepted standard of care for several disorders [1] [2] [6]; nevertheless, it is not risk‑free—bleeding, infection, cognitive or psychiatric effects, hardware failures, and even mortality have been documented—so safety must be assessed case‑by‑case and continuously monitored [4] [3] [8].