Functional neurosurgery · UK
Deep brain stimulation, by a specialist movement disorders team.
A precision neuromodulation implant for advanced Parkinson\'s, essential tremor, dystonia and refractory OCD - placed by a functional neurosurgeon with a real DBS list, in a centre with a movement disorders MDT and a nurse-led programming clinic behind them.
Why patients choose us
- 01
A functional neurosurgeon with a real DBS list
Not a general neurosurgeon who does the occasional case. A named surgeon with a movement disorders MDT and a nurse-led programming clinic behind them.
- 02
The right target for your disorder
STN for advanced Parkinson's, GPi for dystonia, VIM for tremor, nucleus accumbens for refractory OCD. We match target to symptom pattern, not to habit.
- 03
Independent, and free
We are paid by no hospital, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private DBS costs in London.
Indicative ranges across our partner centres. Send the neurology letter and we quote firm figures across two or three options.
In short
Bilateral DBS in a London centre: £65,000 to £95,000, home in 1 to 2 days.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Second-opinion review (letters, MRI, med list) | £450–£750 | 45 min | 48 hours |
| Full DBS work-up (MRI, levodopa challenge, neuropsych) | £3,500–£6,000 | 2–3 visits | 3–4 weeks |
| Bilateral DBS with primary-cell IPG | £65,000–£78,000 | 1–2 day admission | 2–4 weeks to date |
| Bilateral DBS with rechargeable IPG (Percept RC / Vercise Genus) | £78,000–£95,000 | 1–2 day admission | 2–4 weeks to date |
| IPG replacement (end of battery life) | £18,000–£28,000 | Day case | 1–2 weeks |
| Programming session (per visit) | £250–£450 | 45–90 min | Same visit |
Prices vary by centre, by surgeon, by hardware manufacturer (Medtronic Percept PC/RC, Boston Vercise Genus, Abbott Infinity), by primary-cell versus rechargeable IPG, and by length of admission. We come back with a firm quote within one working day.
The journey
From first letter to first switch-on - what happens, in order.
One team from referral through work-up, surgery, IPG placement, initial programming and long-term titration.
- 01
Before
You send us the neurology letter and med list
A short, confidential form. Diagnosis, duration, motor fluctuations, current medications, any prior neuropsychology.
- 02
Before
We come back with a recommendation
Within one working day: whether you are a DBS candidate, whether focused ultrasound thalamotomy or apomorphine/Duodopa fits better, an indicative price and a shortlist of centres.
- 03
Before
Work-up: MRI, levodopa challenge, neuropsych
Volumetric 3T MRI, on/off levodopa UPDRS challenge, formal neuropsychology and psychiatric review, then MDT sign-off before a date is offered.
- 04
On the day
Frame or robot, MRI-guided planning
A stereotactic frame or a frameless robotic platform (Neuromate, ROSA) is used for trajectory planning on intra-operative or fused pre-operative MRI.
- 05
On the day
Lead placement (awake or asleep)
90 to 180 minutes per lead. Awake with microelectrode recording and test stimulation, or asleep DBS with intra-operative MRI or O-arm CT for pure image-guided placement.
- 06
On the day
IPG placement in the chest
A separate short general anaesthetic (same day or 1 to 2 weeks later) to tunnel the extension leads and place the pulse generator under the collarbone.
- 07
After
Initial programming and titration
First switch-on at 2 to 4 weeks. Programming, medication reduction and pulse-width tuning continue over 3 to 6 months, then annual review.
When it helps
When DBS is the right step - and when it is not.
The phenotypes DBS helps most, plus the red flags (atypical parkinsonism, dementia, active psychosis) that mean DBS is off the table.
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Advanced Parkinson's with motor fluctuations
Wearing-off, unpredictable off-periods and troublesome dyskinesia despite optimised oral therapy - STN DBS is the workhorse.
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Levodopa-responsive but dose-limited
A clear on-response to levodopa, limited only by dyskinesia or dose-related side effects - the classic EARLYSTIM and PD-SURG phenotype.
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Essential tremor, medication refractory
Disabling action or postural tremor uncontrolled by propranolol and primidone - VIM thalamic DBS gives 70 to 90 percent tremor reduction.
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Generalised or segmental dystonia
DYT1 and idiopathic generalised dystonia, cervical dystonia not helped by botulinum toxin - bilateral GPi DBS is well established.
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Refractory OCD (specialist centres only)
Severe treatment-refractory OCD after adequate CBT and SSRI/clomipramine trials - nucleus accumbens / ventral capsule DBS under a strict MDT protocol.
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Tremor-predominant Parkinson's
A tremor-dominant PD phenotype where oral therapy is failing - STN or VIM depending on the wider motor picture and MDT view.
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Not a candidate: significant cognitive decline
Moderate to severe dementia, active psychosis or severe untreated depression are contraindications - we say so before you spend on work-up.
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Red flag: atypical parkinsonism
PSP, MSA and CBD do not benefit from DBS and can worsen. A clear levodopa response and typical PD features are essential.
Targets and technique
DBS is a family of procedures - matched to your disorder.
What each target and technique actually involves - and which fits which patient. For refractory OCD and treatment-resistant depression, only specialist centres with an ethical committee accept referrals.
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STN (subthalamic nucleus) DBS
The commonest target for Parkinson's - typically allows a 50 percent medication reduction, improves off-med UPDRS motor scores by 30 to 50 percent, and reduces dyskinesia via lower drug doses.
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GPi (globus pallidus interna) DBS
The target of choice for dystonia and an alternative for PD when cognition or mood are borderline - direct anti-dyskinetic effect, less medication reduction than STN.
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VIM (thalamic) DBS
The classic target for essential tremor and tremor-predominant PD - 70 to 90 percent tremor reduction. Habituation over years is a known limitation.
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Nucleus accumbens / ALIC DBS
Reserved for refractory OCD and, in trials, treatment-resistant depression - only offered in specialist psychiatric-neurosurgical centres under MDT and ethical governance.
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Awake DBS with microelectrode recording
The traditional approach - patient awake for test stimulation, microelectrode recording confirms nucleus boundaries. Longer, more demanding for the patient, high anatomical precision.
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Asleep, image-guided DBS
Under general anaesthesia with intra-operative MRI or O-arm CT - shorter, better tolerated in anxious patients or severe off-med tremor, no intra-operative test stimulation.
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Frame-based vs frameless robotic
Leksell or CRW frames remain the gold standard for accuracy. Frameless robotic platforms (Neuromate, ROSA, Mazor) match sub-millimetre accuracy and are more comfortable.
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Rechargeable vs primary-cell IPG
Primary cell lasts 3 to 5 years then needs replacement. Rechargeable (Percept RC, Vercise Genus R16) lasts 15 to 25 years and needs a 30 to 60 minute weekly charge.
Our London centres
A small panel of DBS centres, we picked them.
Introductions are made privately once we understand your case.
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National Hospital for Neurology and Neurosurgery (UCLH Private)
Queen Square. The UK's longest-standing DBS pathway, with functional neurosurgery, movement disorders neurology and neuropsychology in one place.
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King's College Hospital Private
Denmark Hill. High-volume DBS unit with strong dystonia and PD services and a nurse-led programming clinic.
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Cleveland Clinic London
Grosvenor Place. A modern private-only site running a full functional neurosurgery service with intra-operative imaging.
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HCA The Wellington
St John's Wood. Private DBS with visiting consultant neurosurgeons and neurologists from central London teaching hospitals.
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Imperial Private (Charing Cross)
Fulham Palace Road. DBS delivered within the Charing Cross functional neurosurgery unit under a private pathway.
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Functional neurosurgeons with high annual DBS case volumes
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A movement disorders MDT with nurse-led programming clinic
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MRI-conditional systems (Medtronic Percept PC/RC, Boston Vercise Genus, Abbott Infinity)
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Neuropsychology, psychiatry and speech therapy on tap for work-up and after-care
Safety, outcomes and recovery
What to expect afterwards - honestly.
DBS is a well-established therapy with a real complication profile. The things worth planning are the 1 to 2 percent haemorrhage risk, the programming period and the long-term battery strategy.
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Haemorrhage: 1 to 2 percent per lead
The main serious risk. Symptomatic intracerebral haemorrhage occurs in around 1 to 2 percent of implants. Careful trajectory planning to avoid cortical vessels and sulci lowers the risk.
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Infection: 3 to 5 percent
Infection at the burr hole, extension or IPG pocket. Most respond to antibiotics; some need lead or IPG removal. Meticulous surgical technique and short operating time matter.
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Lead migration or fracture
Uncommon (under 2 percent) but may need revision surgery. Modern segmented leads and improved anchoring reduce the rate.
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Speech, gait and cognitive side effects
Dysarthria, gait freezing and mild frontal-executive changes can occur - often addressable with reprogramming or medication changes. Neuropsychology screening at work-up flags high-risk patients.
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Mood changes
Depression, apathy, hypomania and impulsivity are recognised. A pre-operative psychiatric review is not optional.
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MRI-conditional, not MRI-safe
Modern systems (Percept PC/RC, Vercise Genus, Infinity) allow full-body 1.5T and 3T MRI under specified conditions - always tell the radiographer you have DBS.
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Realistic outcomes - Parkinson's
30 to 50 percent improvement in off-medication UPDRS motor score, 50 percent reduction in medication, marked reduction in dyskinesia and off-time. Not a cure - the disease progresses.
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Realistic outcomes - tremor and dystonia
Essential tremor: 70 to 90 percent reduction in tremor amplitude. Generalised dystonia: 50 to 70 percent improvement over 6 to 12 months. OCD: 40 to 60 percent responder rate.
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Battery life and replacement
Primary cell: 3 to 5 years then a 45-minute day-case IPG swap. Rechargeable: 15 to 25 years with weekly charging - discussed carefully at work-up.
Reading your operative note
Your DBS note in four parts. Read the last one first.
Whichever target and hardware were used, the note the surgeon sends you keeps to the same shape.
- 01 Header
Diagnosis, target and hardware
Which disorder, which target(s), which lead model (Medtronic 3389, Boston Vercise Cartesia, Abbott directional), and which IPG (primary cell or rechargeable).
- 02 Technique
Frame, imaging and confirmation
Frame or robot, planning MRI and intra-operative confirmation (iMRI, O-arm CT, microelectrode recording), and final lead coordinates in AC-PC space.
- 03 Findings
Intra-operative response and any events
Threshold for benefit and for side effects on test stimulation, any bleeding or CSF loss, and confirmed lead position on post-op imaging.
- 04 Impression
Programming plan and follow-up
Read this first: initial switch-on date, expected titration window, medication reduction plan and MDT review interval.
Recognised by major UK insurers
Cover for DBS varies by insurer and by indication - usually funded when medically indicated for advanced PD, essential tremor or dystonia. We confirm cover before booking.
Frequently asked
Everything we get asked about DBS.
Quick answers on candidacy, awake versus asleep, cost, risks and London centres.
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What is deep brain stimulation (DBS)?
DBS is an implanted neuromodulation system. Two thin electrodes are placed precisely in specific brain nuclei (STN, GPi, VIM or nucleus accumbens) through small burr holes in the skull. Extension leads run under the scalp and down the neck to an implantable pulse generator (IPG) placed under the skin below the collarbone. The IPG delivers continuous electrical pulses that modulate abnormal brain circuit activity.
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Am I a candidate for DBS in Parkinson's?
The classic candidate has idiopathic Parkinson's of at least 5 years, a clear on-response to levodopa, disabling motor fluctuations or dyskinesia despite optimised oral therapy, and no significant cognitive impairment or untreated psychiatric disease. The EARLYSTIM trial extended eligibility to earlier motor fluctuations. Every candidate is discussed at an MDT after a formal work-up.
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How much does private DBS cost in the UK?
A bilateral DBS implant with a primary-cell IPG typically costs £65,000 to £78,000. A rechargeable system (Medtronic Percept RC, Boston Vercise Genus R16) is £78,000 to £95,000. An IPG replacement at end of battery life is £18,000 to £28,000. Full pre-operative work-up is £3,500 to £6,000. We confirm firm figures within one working day.
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Awake or asleep - which is better?
Both are legitimate. Awake surgery with microelectrode recording allows real-time test stimulation and physiological confirmation of the nucleus. Asleep image-guided DBS (iMRI or O-arm CT) is shorter, more comfortable for anxious patients or those with severe off-med tremor, and modern imaging matches awake accuracy in experienced centres. The choice depends on the surgeon, the target and you.
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What are the real risks?
Symptomatic intracerebral haemorrhage occurs in around 1 to 2 percent of implants. Infection at the burr hole or IPG pocket is 3 to 5 percent, occasionally requiring hardware removal. Lead migration or fracture is under 2 percent. Speech, gait and mood side effects can occur and are usually manageable with reprogramming. DBS does not cause dementia.
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Where in London is private DBS offered?
The main private DBS pathways in London run through the National Hospital for Neurology and Neurosurgery UCLH Private, King's College Hospital Private, Cleveland Clinic London, HCA The Wellington and Imperial Private Charing Cross. We introduce you to the surgeon and team best matched to your diagnosis and target after we have read your letters.
Ready to talk to a DBS surgeon?
Send us the neurology letter. We come back within one working day with a shortlist and a firm price.
No cost, no obligation. If DBS is not the right answer for you, we will say so and point you to focused ultrasound thalamotomy or advanced medical therapies instead.
Related treatments and conditions
Looking for something else?
-
Focused ultrasound thalamotomy
Incisionless MR-guided FUS for tremor - an alternative to VIM DBS.
Learn more -
Advanced PD therapies (apomorphine, Duodopa)
Pump-delivered dopaminergic therapy for advanced Parkinson's.
Learn more -
Movement disorders service
The full movement disorders pathway - PD, tremor, dystonia, ataxia.
Learn more -
Parkinson's disease
Diagnosis, staging and treatment of Parkinson's across its course.
Learn more -
Essential tremor
Diagnosis and modern treatment of essential tremor including DBS and FUS.
Learn more -
Dystonia botulinum toxin clinic
Injections for cervical, focal and segmental dystonia.
Learn more