The result of deep brain stimulation for dystonia depends above all on three things: the experience and care of the surgeon, the precision of the brain imaging used to plan the operation, and the quality of the DBS technology implanted and programmed. The target in the globus pallidus is only a few millimetres across, and in dystonia the benefit builds over months of careful programming, so small differences in placement and follow-up change the outcome.
At Neuromodulation in Turkey, Prof. Atilla YILMAZ, MD has performed 1,200+ neuromodulation procedures, including 800+ DBS surgeries, for patients from 60+ countries, dedicates his surgical practice to deep brain stimulation, and plans every operation on 3 Tesla MRI. Prof. YILMAZ was the first surgeon in Turkey to use the Abbott Liberta RC™ system with NeuroSphere™ Virtual Clinic remote programming and the Medtronic Percept™ BrainSense™ adaptive DBS technology.
1. The surgeon: experience and care
Studies of DBS failure in dystonia point repeatedly to the same causes: an electrode placed slightly off target, the wrong patient selected, or programming that was not continued long enough. All three depend on the surgical team. The surgeon’s experience is the single most important factor that the patient can choose.
- Volume. Prof. YILMAZ has performed 800+ DBS surgeries and performs about 150 DBS surgeries a year.
- Focus. He dedicates his surgical practice to deep brain stimulation for movement disorders and selected psychiatric conditions.
- A surgeon who teaches surgeons. Prof. YILMAZ holds official proctorship agreements with Medtronic, Abbott and Boston Scientific — the world's three leading manufacturers of DBS systems appoint him to train other neurosurgeons on their technology. He has trained 40+ neurosurgical fellows and observers from 30 countries, with 164 documented case-side surgical training sessions and 44 neurosurgeons and neurologists personally mentored from more than 25 countries.
- International standing. President of the Middle-Eastern Society for Stereotactic and Functional Neurosurgery (MSSFN), board member of the World Society (WSSFN) and the International Neuromodulation Society (INS), executive committee member of the European Society (ESSFN), and Workshop Director, Stereotactic & Functional Neurosurgery hands-on workshop, 19th World Congress of Neurosurgery (WFNS 2025), Dubai.
- Personal care. Prof. YILMAZ evaluates every patient, performs the operation, closes the wounds himself and follows the programming plan.
Read more on Prof. Atilla YILMAZ, MD.
2. Imaging: 3 Tesla MRI
The globus pallidus internus and the subthalamic nucleus are small structures deep in the brain. The sharper the images, the more precisely the target and a safe path to it can be planned.
- 3 Tesla MRI, with twice the magnetic field strength of standard 1.5 Tesla scanners, gives higher-resolution images of the target.
- Under general anesthesia, so involuntary dystonic movements do not blur the images.
- Contrast-enhanced sequences to plan an electrode path that avoids blood vessels.
- CT after electrode placement, merged with the MRI, to confirm the final position.
3. Technology: the most advanced DBS systems
Modern DBS systems give the team more ways to shape the stimulation and to follow patients after they go home, which matters especially in dystonia, where settings are refined over months.
| Technology | What it does | Why it matters in dystonia |
|---|---|---|
| Directional leads | Steer current toward the target and away from neighbouring structures | More benefit with fewer stimulation side effects |
| Abbott Liberta RC™ with NeuroSphere™ Virtual Clinic | Rechargeable stimulator that can be programmed remotely by secure video call | Dystonia needs frequent adjustments over months; patients abroad can have them from home. Rechargeable batteries suit the higher energy needs of dystonia |
| Medtronic Percept™ with BrainSense™ | Records the brain’s own electrical signals through the implanted electrodes; BrainSense™ adaptive DBS adjusts stimulation automatically in response to them | Recordings help guide programming. Adaptive stimulation is currently approved for Parkinson’s disease; its use in dystonia is being studied |
| Boston Scientific systems | Directional, multiple-source current steering | Fine control of the stimulation field |
A first in Turkey. Prof. YILMAZ was the first surgeon in Turkey to use the Abbott Liberta RC™ system with NeuroSphere™ Virtual Clinic remote programming and the Medtronic Percept™ BrainSense™ adaptive DBS technology.
The best device is the one that fits the patient. Prof. YILMAZ chooses the system with each patient according to the type of dystonia, the expected energy use, the need for remote follow-up and the patient’s preferences.
Other factors that decide the result
- Right patient selection. Isolated, genetic (DYT1) and tardive dystonia respond best; acquired dystonia from brain damage responds less.[1] See am I a candidate?
- Timing. Younger age at surgery and shorter disease duration predict more improvement.[2][3]
- Patient programming. In dystonia the full effect builds over 6–12 months. Long-term programming support is part of our package.
In our own case series, patients treated with DBS for cervical dystonia, Meige syndrome and myoclonus-dystonia have shown more than 90% improvement in their symptoms, based on clinical assessment and documented on video. Individual results vary.
Frequently asked questions
Does the surgeon really change the result of DBS?
Yes. The target is a few millimetres across, and outcomes depend on accurate electrode placement, correct patient selection and expert programming. Choosing an experienced DBS surgeon is the most important decision a patient makes.
Why does 3 Tesla MRI matter for DBS?
3 Tesla MRI shows the small deep-brain targets and blood vessels more clearly than standard scanners, which allows more precise and safer planning.
Is adaptive DBS used for dystonia?
Adaptive DBS with Medtronic Percept™ BrainSense™ is approved for Parkinson’s disease. In dystonia, the sensing function can help guide programming, and adaptive stimulation is under study.
Can my DBS be programmed from my home country?
Yes, for compatible systems such as Abbott Liberta RC™ with NeuroSphere™ Virtual Clinic, settings can be adjusted by secure video call.
Sources
- Andrews C, Aviles-Olmos I, Hariz M, Foltynie T. Which patients with dystonia benefit from deep brain stimulation? A metaregression of individual patient outcomes. J Neurol Neurosurg Psychiatry. 2010;81(12):1383–1389. Source
- Hua X, Zhang B, Zheng Z, et al. Predictive factors of outcome in cervical dystonia following deep brain stimulation: an individual patient data meta-analysis. J Neurol. 2020;267(6):1780–1792. doi:10.1007/s00415-020-09765-9 Source
- Artusi CA, Dwivedi A, Romagnolo A, et al. Differential response to pallidal deep brain stimulation among monogenic dystonias: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2020;91(4):426–433. Source