St George’s deep brain stimulation service half a year on

Almost half a year on from starting the UK’s first new deep brain stimulation (DBS) neurosurgical service in half a decade, I am humbled by how our team has pulled together and flattered by the positive and gracious responses we have received from our first ten NHS patients so soon after the initial surgeries.

Two examples include:

I found Mr Pereira to be very open and honest as he explained the long process of DBS surgery to myself and my wife. He took his time, was relaxed and responded to all questions. He is extremely easy to talk to and his confident approach is very reassuring. We both felt inspired by him and knew I was in good hands. He came to see me immediately after the surgery in the recovery area. He calmly gave us an update of how the operation had gone and ensured we knew how to contact him and others if there were any issues during recovery and post-operatively. We’d like to thank him and the entire team involved in my surgery and stay at St George’s, it was an excellent experience.


Mr Pereira took on board all my concerns and acted on them although it made the surgery more complicated for him. He carried out the surgery without shaving any but the smallest patch of my very long hair and placed the battery at the top of my breast where it is invisible except with the lowest of necklines. Psychologically it helped so much. After fine tuning the stimulator I am feeling much better and can’t thank him and the St George’s team enough.

I can’t help but smile at the hyperbole of another patient:

Mr Pereira is quite simply the best of the best. Although his own brain must be the size of a small country and he has a talent given to very few people in the world, his ego is tiny and his compassion and humanity are great. DBS is not everyone’s idea of fun but he took time to explain it in the weeks before the operation in layman’s language, he was open and honest about the risks, and on the day itself he had an air of quiet authority which was immensely reassuring .And he was kind.

In my view, Mr. Pereira is a credit to neurosurgery, to the whole medical profession and to mankind.

There have been and continue to be challenges, difficulties and areas for improvement.  Nonetheless, achievements of the service to be proud of include that we have evolved slick and comfortable awake assessment during surgery and accurate electrode placement with no need for revisions and no infections so far in our early cohort.  We are implanting and programming deep brain stimulators from the three major manufacturers: Boston Scientific, Medtronic and Abbott / St Jude Medical.  We have appointed a superbly qualified service coordinator and expanded our clinical nurse specialist commitment.  Our expert academic neurologists have begun to gain support and salaries for their NHS commitments (which I hope will continue!) and we are starting to develop novel and exciting research projects around Parkinson’s disease, other movement disorders and neuromodulation in general.

All of this is a great excuse for our hard working team to share a celebratory cake!


The first deep brain stimulation surgery at St George’s Hospital, London.

I performed the first ever deep brain stimulation surgery at St George’s Hospital for Parkinson’s disease in September 2016.  This was the culmination of three months of intensive effort from our dedicated team of neurologists, nurse specialists, managers and operating theatre staff.first DBS.jpgThe happy patient (pictured with permission together with our team – Lucia Ricciardi, Francesca Morgante, Alison Leake and Dominic Paviour) posted a touching testimonial on iwantgreatcare as follows:

I have Parkinson’s disease and for many years have sought to have deep brain stimulation (“DBS”) as a way of managing the effects of this illness. I was fortunate to be selected by the Movement Disorders Team (“MDT”) at St George’s Hospital at an assessment meeting during which I met Mr Pereira for the first time. During the meeting we discussed various aspects of the procedure and I immediately felt a bond with Mr Pereira due to his calm, forthright, assured and confident manner. Everything that I read about him confirmed him to be eminently qualified to perform this operation and so I had no hesitation in proceeding. The operation was performed on the 20th September 2016 at the Atkinson Morley Wing of St George’s Hospital. Before, during and after the operation Mr Pereira took time to make himself available to me for questions and re-assurance. During the operation, which is fairly invasive and during which I was kept awake, Mr Pereira kept a dialogue going with me to put my mind at rest and to keep me appraised of what they were doing and what stage they had reached. The operation has been a complete success and I look forward to many years of an improved lifestyle due to Mr Pereira’s skills as a surgeon and as a personable and approachable person. The wounds created by the operation have fully healed and were very neatly performed. I recommend Mr Pereira most highly as a skilled and caring neurosurgeon.

Thank you!

Deep brain stimulation is a brain operation where electrodes are inserted deep into the brain with great accuracy, in this case to structures of the basal ganglia to improve signs, symptoms and medication doses in Parkinson’s disease.  The electrodes are connected to a ‘brain pacemaker’.  Thousands of people have received the treatment worldwide.  I learnt the nuances of this operation in a craft apprenticeship with Professor Tipu Aziz in Oxford over the last decade.