RESToRe Lab
Penn Neurosurgery
For patients & families

If you've been told you may need brain or nerve surgery — start here.

This page is for people who have been referred to Dr. Cajigas, are considering a referral, or simply want to understand what we do before talking with their own doctor. The language is plain on purpose. Acronyms and clinical terms are explained the first time they appear. If you want to look up a specific term, there is a glossary.

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Comprehensive Epilepsy Center
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Movement Disorders Center
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Comprehensive Stroke Center
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Are you here because…

Four common reasons people come to us.

Pick the one that fits. Each link jumps to the section of this page that explains the conditions we treat, the procedures we offer, and what the path looks like.

// Track A

I have a movement disorder.

Parkinson's disease, essential tremor, or dystonia — and medications alone aren't doing enough.

Read what we offer →
// Track B

I have epilepsy or seizures.

Seizures that haven't fully responded to medications, and the question of whether surgery could help has come up.

Read what we offer →
// Track C

I have face pain or nerve pain.

Trigeminal neuralgia, occipital neuralgia, refractory back pain, CRPS, painful diabetic neuropathy, or refractory headache when other treatments haven't been enough.

Read what we offer →
// Track D

I had a stroke and my arm hasn't fully recovered.

An ischemic stroke 6+ months ago, with persistent arm or hand weakness — and you want to try something beyond standard rehabilitation.

Read what we offer →
Your physician
Dr. Iahn Cajigas, MD, PhD

Dr. Iahn Cajigas, MD, PhD

Neurosurgeon · Assistant Professor of Neurosurgery, Hospital of the University of Pennsylvania

Dr. Cajigas is a neurosurgeon at Penn Medicine. His field is functional and stereotactic neurosurgery. That is the kind of brain surgery used for movement disorders, epilepsy, and pain. He also removes brain tumors and cares for patients with head injuries. His clinic is at Pennsylvania Hospital in Center City Philadelphia. He also sees patients in Lancaster.

He studied medicine and research at Harvard University and MIT. He did his surgical training at the University of Miami and Jackson Memorial Hospital. He then spent an extra year at the University of California, San Francisco, learning surgery for epilepsy.

He is a member of the Penn Comprehensive Epilepsy Center and the Penn Movement Disorders Center. He also works closely with the Penn Comprehensive Stroke Center on nerve stimulation for stroke recovery. These centers evaluate patients as a team. Before anyone suggests surgery, you will usually meet three doctors together: a brain doctor (neurologist), a brain surgeon, and a doctor who focuses on your condition — seizures, movement, or stroke.

Penn Medicine provider profile 800-789-7366 (appointments) Email
Track A · Movement disorders

Movement disorders: Parkinson’s disease, essential tremor, dystonia.

If your hands shake, your body stiffens, you have unwanted movements, or your medications have stopped working, surgery is sometimes an option. We don’t offer surgery as a first step — we work with the neurologists at the Penn Movement Disorders Center to make sure it’s the right next step for you. The right operation depends on the condition, the symptoms that bother you most, and what you can tolerate.

Conditions we treat

  • Parkinson’s disease — for tremor, stiffness, slowness, and medication-related involuntary movements (dyskinesia).
  • Essential tremor — when medications have stopped controlling the shaking.
  • Dystonia — generalized, focal (cervical, blepharospasm), and severe acute episodes (status dystonicus).

Procedures we offer

DBS
MRgFUS
LITT
  • Deep brain stimulation (DBS) — a thin wire is placed in a specific brain area and connected to a small pacemaker-like device under the skin. The settings can be adjusted in clinic over time. The brain target depends on what you have:
    • For Parkinson’s disease: subthalamic nucleus (STN) or internal globus pallidus (GPi)
    • For essential tremor: ventral intermediate nucleus of the thalamus (VIM)
    • For dystonia: GPi or STN — full FDA approval (Medtronic) for chronic, intractable primary dystonia, including generalized, segmental, and cervical dystonia in adults, and primary generalized dystonia in patients age 12 and older
  • MR-guided focused ultrasound (MRgFUS) — sound waves are focused through the skull to create a small lesion in a single session. No incision, no implant.
    • For essential tremor: unilateral thalamotomy (FDA-approved 2016)
    • For tremor-dominant Parkinson’s: unilateral thalamotomy (2018), expanded in 2021 to also address mobility, rigidity, and dyskinesia
    • For advanced Parkinson’s: staged bilateral pallidothalamic tractotomy (FDA-approved 2025; the second side is treated at least nine months after the first)
  • Gamma Knife radiosurgery (stereotactic radiosurgery) — focused radiation through a fitted frame, no incision. Used as an alternative when DBS or MRgFUS aren’t feasible (for example, patients on blood thinners, with bleeding risk, or who cannot tolerate surgery). The tremor benefit develops gradually over months.
  • Laser interstitial thermal therapy (LITT) — minimally invasive MRI-guided ablation through a small skull opening. Used in select cases where a focal lesion is preferred over a stimulator (for example, status dystonicus or when DBS hardware can’t be tolerated). Less commonly used for movement disorders than for epilepsy.
Deep brain stimulation (DBS): a thin lead enters through a small skull opening at an angle, off the midline, and reaches a deep target — for Parkinson's disease, the subthalamic nucleus (STN), below the thalamus. A cable runs under the skin to a pulse generator (IPG) under the collarbone; the settings are adjusted in clinic, with no further brain surgery.
Deep brain stimulation (DBS): a thin lead enters through a small skull opening at an angle, off the midline, and reaches a deep target — for Parkinson's disease, the subthalamic nucleus (STN), below the thalamus. A cable runs under the skin to a pulse generator (IPG) under the collarbone; the settings are adjusted in clinic, with no further brain surgery.
Tremor: comparing surgical options

Four ways to treat severe tremor: at a glance.

For essential tremor, and for tremor-predominant Parkinson's disease, several surgical options exist. They share one goal — reaching the same small target deep in the brain (the VIM, a nucleus in the lateral thalamus) — but differ in how they get there: how invasive it is, how fast it works, whether it can be adjusted later, and which patients it suits. The table below is a starting point for the conversation, not a decision. The right choice depends on your specific situation, and we work through it with you in clinic.

Four ways to reach the same tremor target — the VIM, a nucleus in the lateral thalamus on one side. Deep brain stimulation places a lead that stays. Focused ultrasound and Gamma Knife make a small permanent lesion (thalamotomy) with no incision, using converging beams. A laser (LITT) probe makes the lesion through a small skull opening.
Deep brain stimulationA lead that stays — adjustable in clinic
Focused ultrasound (MRgFUS)Lesion · no incision
Gamma KnifeLesion · no incision
Laser thalamotomy (LITT)Lesion · small skull opening
All four treat the same target — the VIM, a nucleus in the lateral thalamus on one side (shown in cyan). DBS places a lead that stays and can be adjusted; the other three make a small permanent lesion (thalamotomy) in that spot.
Deep brain stimulation (DBS) MR-guided focused ultrasound (MRgFUS) Stereotactic radiosurgery (Gamma Knife) Laser thalamotomy (LITT)
What we do Place a thin wire into the VIM area of the thalamus and connect it to a small pacemaker-like device under the skin. Use focused sound waves through the skull to make a small lesion in the same brain target. No incision, no implant. Use focused radiation through a fitted frame to make a small lesion in the same brain target. No incision, no implant. Pass a thin laser fiber through a few-millimeter skull opening to the same brain target and, watched in real time on MRI, use heat to make a small lesion. No permanent implant.
Incision and hardware Yes. Small scalp incisions and a chest incision for the device. No incision. No implant. No incision. No implant. A small scalp incision and a few-millimeter skull opening. No permanent implant.
Anesthesia Often awake for the test portion (so we can confirm the lead is in the right spot), then asleep for the device implant. Awake throughout, in the MRI scanner. Awake throughout. The frame is placed under local anesthesia. Asleep (general anesthesia).
Hospital stay One to two nights. Same day. Most patients go home that evening. Same day. Most patients go home that evening. One to two nights.
One side or both? Both sides can be treated, in the same operation or staged. Approved for staged bilateral treatment, with the second side at least nine months after the first (FDA, 2022). Usually one side only. Bilateral Gamma Knife thalamotomy is rarely offered. One site at a time.
When does the benefit appear? Immediately on the operating table when the lead is tested, then refined over the first six months as the device is programmed. Immediately, on the table, in the MRI scanner. Gradually, over three to six months. Immediately, once the lesion is made. No programming needed.
Can it be adjusted later? Yes. Settings are changed in clinic over time, and can be fine-tuned as your tremor changes. No. The lesion is permanent. No. The lesion is permanent. No. The lesion is permanent.
Long-term considerations Battery replacement every several years, and ongoing programming visits. Some patients see a gradual loss of tremor benefit over years (called habituation), which can sometimes be managed by reprogramming. A single permanent treatment. Some patients see a partial return of tremor over years. A single permanent treatment. Less long-term data than DBS or MRgFUS. A single permanent treatment. As a newer image-guided approach, LITT has less long-term tremor-outcome data than radiofrequency (RF) thalamotomy, the original lesioning method.
If you take blood thinners Blood thinners must be held before surgery. May not be appropriate if they cannot be safely held. Often suitable, since there is no incision. Often suitable, since there is no incision. Must be held before the procedure, since it involves a scalp incision and a small skull opening.
FDA approval for essential tremor 1997 (DBS of the VIM thalamus). 2016 (unilateral). 2022 (staged bilateral, second side at nine months or later). Used as an alternative when DBS and MRgFUS are not feasible. Performed under the broader FDA clearance for stereotactic radiosurgery. Offered in select cases when MRgFUS is not a good fit (for example, skull anatomy). Performed under the FDA clearance for laser ablation of brain tissue.
A note on radiofrequency (RF) thalamotomy

Radiofrequency (RF) thalamotomy, the original lesional approach to tremor, is not currently offered at Penn. In modern practice it has been largely replaced by MRgFUS, Gamma Knife, and LITT, which can produce similar tremor benefit using less invasive or more precisely controlled approaches.

Risk and complication profiles for each of these procedures are part of the in-person discussion in clinic. They depend on your individual anatomy, medical history, and goals, and we walk through them with you before any procedure is recommended.

Track B · Epilepsy & seizures

Epilepsy & seizures: drug-resistant epilepsy and surgical evaluation.

If you have seizures that haven't fully responded to medications, you may be a candidate for a surgical evaluation. The first step is almost never surgery — it's a careful workup with the team at the Penn Comprehensive Epilepsy Center to find out where in the brain your seizures are starting and decide which option fits best. Some patients are best served by removing or ablating a small area; others are better served by a device that delivers stimulation. We offer all of these.

Conditions we treat

  • Drug-resistant epilepsy — seizures that haven't fully responded to two or more medications.
  • Focal seizures — seizures that start in a specific part of the brain.
  • Mesial temporal lobe epilepsy with hippocampal sclerosis — the most common form of focal epilepsy in adults.
  • Lesional epilepsy — seizures from a tumor, cortical dysplasia, or cavernoma.
  • Hypothalamic hamartoma — a rare deep-brain lesion that causes seizures, treatable with LITT.
  • Bilateral or eloquent-cortex seizure foci — when seizures come from both sides of the brain or from areas that can't safely be removed.

Procedures we offer

SEEG
RESECTION
LITT
DBS-ANT
VNS
  • Stereo-EEG (SEEG) monitoring — a short hospital stay where thin recording electrodes are placed in specific deep parts of the brain to track your seizures and pinpoint where they start. This is the diagnostic step that guides which treatment comes next.
  • Anterior temporal lobectomy / selective amygdalohippocampectomy — open surgery to remove the small area where seizures start. The selective version preserves more surrounding brain tissue when only the deep mesial structures are involved. In carefully selected patients this offers the best chance of becoming seizure-free of any of these options. Your team will discuss the numbers that apply to your specific situation.
  • Lesionectomy — surgical removal of a tumor, cortical dysplasia, or cavernoma that's causing seizures.
  • Laser interstitial thermal therapy (LITT) — a thin laser fiber is guided through a small skull opening to gently heat and stop the small area of brain tissue causing seizures. Used for mesial temporal lobe epilepsy (a procedure called SLAH, short for stereotactic laser amygdalohippocampotomy — laser treatment of the two deep structures where these seizures usually start) and for hypothalamic hamartomas. Usually a 1–2 day hospital stay; better cognitive recovery than open resection in many cases.
  • Vagus nerve stimulation (VNS) — a small pacemaker-like device in the chest connected to a wire wrapped around a nerve in the neck. Adjunctive (added on top of medications); aim is reducing seizure frequency rather than seizure-freedom.
  • Responsive neurostimulation (RNS, NeuroPace) — a small device implanted in the skull with one or two leads placed at the seizure focus. The device continually monitors your brain activity and delivers a brief, imperceptible stimulation when it detects abnormal patterns — often before a seizure becomes noticeable. Useful when seizures come from two foci, both sides of the brain, or from areas that can't safely be removed. In a nine-year study of 230 patients, seizures fell by a median of 75%, and about one patient in five had at least a full year with no seizures. Nair et al., Neurology 2020.
  • Deep brain stimulation of the anterior thalamus (DBS-ANT) — bilateral DBS in the anterior thalamic nucleus to reduce focal seizure frequency. FDA-approved in 2018 based on the SANTE trial (Stimulation of the Anterior Nucleus of Thalamus for Epilepsy). At five years, seizures had fallen by a median of 69%, and about two-thirds of people had at least half as many seizures as before. Risks are part of the conversation in clinic before you decide. Salanova et al., Neurology 2015.
Track C · Pain

Face pain, back pain, and nerve pain that hasn't responded to other treatment.

Most pain is best treated by a primary doctor or pain specialist. We treat specific kinds of nerve pain — usually after medications and other approaches haven't been enough — and we also evaluate spinal pain that might benefit from spine surgery or a stimulator. Most of what we offer is neuromodulation: small implanted devices that calm the nerves carrying the pain signal, without destroying any tissue. The right device depends on where your pain is and what kind of nerves are involved. Almost every device begins with a temporary trial so you can see whether it works for you before anything is permanently implanted.

Conditions we treat

  • Trigeminal neuralgia — severe, sudden, electric-shock-like facial pain.
  • Occipital neuralgia — sharp, shooting pain at the back of the head.
  • Refractory chronic back and leg pain — including pain after spine surgery (sometimes called failed back surgery syndrome) and chronic radicular pain.
  • Complex regional pain syndrome (CRPS) — burning, color-changing, hypersensitive pain in a hand, foot, or limb, often after an injury or surgery.
  • Painful diabetic neuropathy — burning or shooting nerve pain in the feet from long-standing diabetes.
  • Refractory chronic migraine and cluster headache — when the standard medications and CGRP blockers haven't been enough. (CGRP blockers are a newer class of migraine medicine — the name stands for calcitonin gene-related peptide.)
  • Persistent post-surgical neuropathic pain — including post-mastectomy, post-thoracotomy, post-amputation, and groin pain after hernia repair.
  • Chiari malformation — when the lower brain extends into the spinal canal and causes symptoms.

Procedures we offer

SCS
PNS
DRG
  • Microvascular decompression (MVD) — surgery to take pressure off the trigeminal nerve from a nearby blood vessel. Often the most durable option for classical trigeminal neuralgia.
  • Percutaneous procedures for trigeminal neuralgia — short outpatient procedures done through a needle in the cheek under brief anesthesia (glycerol rhizotomy, balloon compression, radiofrequency rhizotomy). They interrupt the trigeminal nerve's pain fibers. Less invasive than MVD but typically shorter-lasting.
  • Gamma Knife radiosurgery — focused radiation directed at the trigeminal nerve. No incision; pain relief usually develops over weeks to months.
  • Spinal cord stimulation (SCS) — a small implanted device with thin wires placed in the epidural space that delivers gentle electrical pulses to the spinal cord. Used most often for chronic back-and-leg pain after spine surgery, CRPS, and painful diabetic neuropathy. Modern devices offer multiple stimulation patterns (tonic, burst, and high-frequency 10-kHz) — the right one depends on what works best for you in trial.
  • Dorsal root ganglion (DRG) stimulation — a more focal form of stimulation. A thin lead sits next to one of the small "switchboards" on the spinal nerve roots, just outside the spinal cord. Best for chronic pain that travels along a single nerve (down one leg, into one foot, or into the groin) and for stubborn distal pain — like foot pain — that broader spinal cord stimulation can't reliably reach. Common reasons: CRPS of a lower limb (the FDA-approved use), persistent pain after groin or spine surgery, or focal nerve-root pain that survived earlier treatment.
  • Peripheral nerve stimulation (PNS) — a small device with leads placed near a specific nerve causing pain (for example, in the shoulder, knee, foot, or after amputation). Some PNS systems are designed as a temporary 60-day implant; others are permanent. Modern wireless systems (Nalu, StimRouter) have no internal battery — a small skin-worn transmitter delivers power transcutaneously to the implanted lead.
  • Occipital nerve stimulation (ONS) — leads placed under the skin at the back of the head over the occipital nerves, connected to a small chest IPG. Used for refractory occipital neuralgia, chronic migraine, and cluster headache when other options haven't worked.
  • Trigeminal nerve field stimulation — leads placed under the skin of the face along the painful trigeminal branches, for refractory trigeminal pain when surgery and medications haven't been enough. Reversible — no nerve tissue is destroyed.
  • Intrathecal drug-delivery pump — a small pump implanted in the abdomen that delivers pain medication directly to the spinal fluid, achieving better pain control at much lower doses than oral or IV medication.
  • Spine surgical evaluation — for back or leg pain that may need surgical treatment of the underlying problem (disc, stenosis, instability) before — or instead of — a stimulator.
How we choose between devices

The choice between SCS, DRG, and PNS comes down to where your pain is and what nerves carry it. SCS is best for broad areas like both legs or the lower back. DRG focuses on a smaller, anatomically specific area like one foot or the groin. PNS targets one peripheral nerve, like the suprascapular nerve in the shoulder. ONS and trigeminal field stimulation are versions of PNS for very specific head and face pain. We do a careful evaluation — including a temporary trial of the device — before any permanent implant.

Track D · Stroke recovery

Stroke — paired VNS therapy for chronic arm and hand recovery.

If you had an ischemic stroke six or more months ago and your arm or hand still hasn't fully recovered, paired vagus nerve stimulation (paired VNS) may help. It combines a small implanted device with intensive rehabilitation to help your brain rebuild the connections that move your arm — even years after the stroke.

Who is a candidate

  • Chronic ischemic stroke — the stroke happened at least 6 months ago. Many patients in the original trial were 1 to 3 years out.
  • Moderate-to-severe arm weakness that hasn't fully recovered with standard rehabilitation alone.
  • Some preserved arm and hand movement — you can move your wrist, your thumb, and at least two fingers a little.
  • Motivation to commit to rehab — the device works with therapy, not instead of it. The protocol is intensive (multiple sessions per week for about six weeks, plus daily practice at home).

What we offer

Paired VNS
  • Paired vagus nerve stimulation (paired VNS) — a small pacemaker-like generator sits on the left chest, just under the collarbone, and a thin wire is tunneled under the skin to gently wrap around the left vagus nerve in the neck. The surgery is short (about an hour) and most patients go home the same day or the next morning.
  • Paired rehabilitation — during therapy sessions, your therapist triggers a brief, painless stimulation each time you successfully attempt a movement. The stimulation pairs with the action and helps your brain reinforce the pathway. After the in-clinic block, you continue at home using a magnet you wave over the device while practicing daily activities.
  • Standard stroke rehabilitation — physical therapy, occupational therapy, and the full multidisciplinary stroke team at the Penn Comprehensive Stroke Center.
What the evidence shows

Paired VNS was FDA-approved in 2021 based on the VNS-REHAB pivotal trial (Dawson et al., Lancet 2021): a randomized, triple-blind, sham-controlled trial of 108 patients with chronic ischemic stroke and moderate-to-severe arm impairment. Patients who received paired VNS plus rehabilitation showed roughly two to three times more improvement in arm function than patients who received the same intensive rehabilitation alone. Most participants were 1–3 years post-stroke at enrollment.

If you'd like to be evaluated for paired VNS therapy, ask your neurologist or rehab physician for a referral, or use the three contact options below to reach the clinic directly. The first visit is a team visit. You will see a brain surgeon, a stroke doctor, and a rehabilitation doctor, who together confirm whether this is a good fit for you.

Where you'll be seen

Two clinic locations.

Most patients are first seen at Pennsylvania Hospital in Center City Philadelphia. A second clinic in Lancaster is available for patients in central Pennsylvania.

// Primary clinic

Penn Neurosurgery — Pennsylvania Hospital

801 Spruce Street
Philadelphia, PA 19107

Phone: 215-829-6700

Hospital affiliations: Hospital of the University of Pennsylvania · Pennsylvania Hospital · Penn Presbyterian Medical Center.

Get directions on Google Maps →
// Lancaster clinic

LG Health Physicians Neurology — Harrisburg Pike

2150 Harrisburg Pike
Lancaster, PA 17601

Phone: 717-396-9167

For patients in central Pennsylvania who can't easily travel to Philadelphia for follow-up.

Get directions on Google Maps →
Who you'll meet

Your clinical team.

When you come to clinic — and on the day of surgery — these are the people you'll work with most closely. Each role covers a different step of your care, from your first appointment through long-term follow-up.

Jamie Passaro, CRNP

Nurse practitioner — Penn Movement Disorders Center

Jamie sees patients in clinic for movement disorders, epilepsy, and facial pain conditions, alongside the surgical and procedural pathways those conditions involve.

View profile on Penn Medicine →

Denise Miller, MSN, CRNP

Denise Miller, MSN, CRNP

Functional neurosurgery nurse practitioner — Penn Neurosurgery

I am a functional neurosurgery nurse practitioner with Penn Neurosurgery. I provide care for patients before and after surgery as well as patient management with medications and collaborating with our neurology colleagues to provide a multi-disciplinary approach to your care. I look forward to being part of your care team.

View profile on Penn Medicine →

Justine Devito, BSN, RN

Registered nurse — Penn Neurosurgery

Justine is part of the nursing team that supports patients through surgery and recovery, including questions that come up between visits.

Christine Kucowski, BA

Christine Kucowski, BA

Surgical services coordinator — Penn Neurosurgery

I am the surgical services coordinator for Dr. Cajigas. I help with scheduling for office visits, radiology, and preadmission testing — the appointments that line up before your surgery. I look forward to working with you.

For the lab's research team — graduate students, postdocs, alumni — see the people page.

What patients say

Excerpts from patient reviews.

Selected from 400+ verified patient reviews on Penn Medicine. Quoted exactly as written; identities are not surfaced by Penn.

“Explained everything very well and gave me options.”

— Patient review · Penn Medicine

“They were very nice and didn't mind me asking questions.”

— Patient review · Penn Medicine

“Felt confident in his knowledge and expertise.”

— Patient review · Penn Medicine

These quotes appear in their original English. To read them in another language, use your browser's translation feature.

A no-commitment option

Looking for a second opinion?

You don't need to switch doctors to talk with us. Penn Medicine offers second opinions across the conditions Dr. Cajigas treats — including Parkinson's disease, essential tremor, dystonia, epilepsy and seizure disorders, trigeminal neuralgia, occipital neuralgia, hemifacial spasm, glossopharyngeal neuralgia, and post-stroke arm and hand recovery.

If you've already been seen elsewhere and want a fresh look — or if you've been told you may need surgery and want to confirm it's the right next step — a second-opinion consultation is a way to get a Penn perspective without changing your care team. Visits are available both in person at Pennsylvania Hospital and via telehealth. Dr. Cajigas holds active medical licenses in Pennsylvania, New Jersey, and Delaware, and can see patients across these three states by video; telehealth visits from other states may also be possible depending on that state's regulations on out-of-state providers.

1

Request online

Maybe you have already been seen somewhere else and want a fresh look. Maybe you have been told you may need surgery, and you want to be sure it is the right next step. A second opinion lets you hear from us without leaving your own care team.

You can be seen in person at Pennsylvania Hospital, or by video. Dr. Cajigas is licensed in Pennsylvania, New Jersey, and Delaware. He can see you by video if you live in one of those three states. If you live somewhere else, a video visit may still be possible. The rules are set by each state, so call us and we will check for you.

Penn Medicine second opinions →
2

Call to schedule

Speak with a Penn Medicine intake specialist who can route you to the right team.

800-789-7366
How to be seen

Three ways to make an appointment.

  • 1. Through your current doctor. Ask them to send a referral to Penn Neurosurgery — Functional & Stereotactic Service. This is the most common path and is helpful because your doctor can send your records ahead of the visit.
  • 2. By phone. Call Penn Medicine's main appointment line at 800-789-7366, or call the Pennsylvania Hospital clinic directly at 215-829-6700. Tell them you'd like to schedule with Dr. Cajigas.
  • 3. Through MyPennMedicine. If you are already a Penn patient, you can request the appointment yourself in the MyPennMedicine portal.

Most insurance plans are accepted, including Aetna, Cigna, Independence Blue Cross, UnitedHealthcare, Highmark, Medicare, and Medicaid (PA & NJ). Confirm coverage with your plan before the visit.

// Interested in research?

Many patients ask whether they can also help advance the research while being treated. The lab runs several IRB-approved studies that enroll patients already scheduled for surgery — your participation is voluntary and never affects your clinical care.

Read about research participation →  ·  See active studies →

What happens next

From referral to follow-up: what to expect.

Decisions about brain or nerve surgery are not made in a single visit. The path below is what most patients go through, regardless of which track brought them here. Where the steps differ by condition, that is noted.

  1. Step 01

    Referral or self-referral.

    Most patients arrive with a referral from a neurologist, primary-care physician, or epileptologist. You do not strictly need a referral. But it helps: your doctor can send your scans, notes, and medicine list before the visit, so we can make better use of your time. To request an appointment, call 800-789-7366.

  2. Step 02

    Records review and scheduling.

    Once your records are received, the team reviews them to make sure a surgical evaluation is appropriate at this stage and to schedule you with the right combination of specialists. For movement disorders and epilepsy, we plan this as a team visit. You will usually meet a neurologist and a brain surgeon together, often on the same day.

  3. Step 03

    First visit (45 to 60 minutes).

    A new-patient consultation covers your history, current symptoms, what has and has not worked, and a focused exam. Expect a discussion of options, not a surgical decision. Bring a complete medication list, a copy of any recent brain MRI on a CD or USB if you have one, your questions written down, and ideally a family member or close friend.

  4. Step 04

    Workup, by condition.

    Surgery is rarely the next step after the first visit. The workup that follows depends on your track:

    • Movement disorders: a new brain MRI and memory-and-thinking tests. For Parkinson's, we sometimes do a levodopa challenge — we check how much your symptoms improve on your usual Parkinson's medicine. Your case is then discussed at a team meeting of movement-disorders doctors. Together we work out which procedure (DBS, MRgFUS, Gamma Knife, or LITT) fits your goals.
    • Epilepsy: a detailed MRI and memory-and-thinking tests. You also stay in the hospital for video-EEG, which records your seizures as they happen. Some people also need a PET or SPECT scan (two kinds of nuclear-medicine scan) — these show how active each part of the brain is, not just its shape. Your case is then reviewed by the epilepsy surgery team. Some patients also need stereo-EEG (SEEG) as a separate diagnostic step before any treatment is decided.
    • Pain or facial nerve pain: we review your scans — often a detailed MRI of the trigeminal nerve if you have face pain. We also go through your medicines and what you have already tried. If you may benefit from spinal cord stimulation or DRG, you first get a temporary trial device before anything permanent is placed.
    • Post-stroke arm recovery: we look at the scans from your stroke and check how well your arm moves now. We make sure enough time has passed since the stroke, and we work with your stroke doctor and your therapy team.
  5. Step 05

    The team reviews your case and decides.

    Your case is presented at a team meeting — movement disorders, epilepsy, or pain, depending on your condition. The team agrees on whether surgery is recommended, and if so, which procedure and on which side. We then meet with you again to walk through the recommendation, the alternatives, and the risks. If you would like a second opinion before deciding, we will give you a written summary you can take to another center.

  6. Step 06

    Pre-operative preparation.

    Once you decide to move forward, you will have a pre-operative visit for medical clearance, anesthesia review, and any needed medication adjustments. The team will tell you which medications to hold, when to stop eating, and what to expect on the day of the procedure.

  7. Step 07

    The procedure and hospital stay.

    Length of stay depends on the procedure. MRgFUS and Gamma Knife are usually same-day. LITT is typically one to two nights. DBS is typically one to two nights. SEEG monitoring and staged operations are longer. The specifics for each procedure are described in the track sections above.

  8. Step 08

    Recovery and follow-up.

    Post-operative follow-up varies by procedure. DBS patients return for device activation about two to four weeks after surgery, with several programming visits over the first six months. MRgFUS and Gamma Knife patients are seen within a few weeks of the procedure. Epilepsy patients are followed for at least a year for seizure outcomes. Pain patients are titrated over weeks to months as the device is optimized. We will tell you when you can drive, return to work, and resume exercise based on your specific procedure.

Throughout

You can pause, ask for a second opinion, or change your mind at any point. Family members are welcome at any visit. Video visits are available for patients in Pennsylvania, New Jersey, and Delaware where the type of evaluation allows. If anything is unclear at any step, ask. There is no question too small.

Common questions

Frequently asked questions.

Do I need a referral to be seen?

A referral isn't strictly required, but most patients arrive with one — it lets your doctor send the relevant records (imaging, neurology notes, medication list) ahead of the visit, which makes the consultation more useful. If you'd like to come without one, call 800-789-7366 and ask.

How long is the first visit?

A new-patient consultation is typically 45–60 minutes. For movement disorders and epilepsy, you may also see a neurologist or epileptologist on the same visit — this is the team approach the Penn Comprehensive Epilepsy Center and Movement Disorders Center are built around.

What should I bring?

Bring four things:

  • A list of all the medicines you take, with the doses.
  • A copy of your recent brain MRI on a CD or USB, if you have one. The imaging center that did the scan can usually give you a copy.
  • Your questions, written down.
  • A family member or close friend, if you can. There is a lot to take in, and a second pair of ears always helps.

Will I be awake during deep brain stimulation surgery?

Sometimes, yes. For Parkinson's disease and essential tremor, the test portion of DBS is often done with you awake but very comfortable, because we ask you to do small tasks (tap your fingers, count) so we can confirm we have the lead in the right spot. You won't feel pain — only the brief setup is uncomfortable. The team will walk you through every step.

What's recovery like after laser ablation (LITT) for epilepsy?

Most people stay in the hospital for one or two nights after LITT, then go home. The incision is small (a few millimeters). Most patients return to light activities within a week or two. Seizure outcomes are followed for at least a year. Your epilepsy team will discuss what to expect for your specific situation.

Can my family come with me to appointments?

Yes — and we encourage it. For complex decisions about surgery, having a family member or trusted friend at the visit is genuinely helpful. They can ask questions you didn't think of and help you remember what was said.

Will I be invited to participate in research?

Possibly. Some patients are eligible to take part in research that can be done during a clinically planned procedure — for example, a few minutes of additional brain recording during DBS placement that doesn't change the surgery itself. Participation is always optional, separately consented, and reviewed by Penn's Institutional Review Board. It does not change your clinical care. See the Clinical Trials page for current research areas.

What if I'd like a second opinion?

Encouraged. Decisions about brain or nerve surgery are major. If you'd like a second opinion before deciding, we'll provide a written summary of our recommendations that you can share with another center.

How long after my stroke can I be considered for paired VNS?

The FDA-approved indication is for ischemic stroke at least six months in the past. In the pivotal trial, the average time since stroke was three years, and patients up to ten or more years out were enrolled — meaning recovery is still possible long after most rehabilitation programs end. The earliest you'd be eligible is around 6 months; there is no fixed upper limit, but we evaluate each patient individually.

How is paired VNS different from regular stroke rehab?

Standard rehabilitation works on its own, and many patients see meaningful improvement with it alone. Paired VNS is added on top of high-intensity rehabilitation for patients whose arm function has plateaued and is still moderate-to-severely impaired. The device delivers a brief stimulation paired with each movement attempt, which appears to enhance the brain's ability to relearn the motor task. In the pivotal trial, patients who got paired VNS plus rehab improved 2–3 times more than patients who got the same intensive rehab without the device.

If our work has helped you

Ways to push this work forward.

If you or a family member has been treated by the lab — or if you simply care about advancing care for people with neurological conditions — there are several ways to be part of the work going forward. A philanthropic gift to the lab's Neuro Interventional Research Fund at Penn Medicine is one. Taking part in a study, sharing what we do, and advocating for federal neuroscience funding are others.

Support the lab →   Take part in a study