#74: Ludvic Zrinzo – DBS vs. Lesioning – and how to know you’re right

In this episode of Stimulating Brains, we sit down with Dr. Ludwig Zrinzo, Professor of Functional Neurosurgery at University College London and Head of the Functional Neurosurgery Unit at Queen Square.Drawing on decades of experience at the forefront of deep brain stimulation, Dr. Zrinzo reflects on the evolution of DBS from awake procedures to image-guided surgery under general anesthesia, emphasizing why precision, verification, and closing the loop are essential for improving patient outcomes.We discuss how his experience shaped a rigorous, data-driven approach to targeting, why imaging quality remains a very critical factor in DBS accuracy, and how systematic post-operative verification transformed clinical practice. Beyond technique, Dr. Zrinzo shares deeply insightful perspectives on patient selection, mentorship, leadership, and the responsibility of building sustainable teams in academic neurosurgery.The conversation also ventures into neuropsychiatric DBS, including OCD, where we examine how stimulation in different targets may have differential effects on behavior, illuminating the brain’s underlying circuitry. Finally, we look into the future of adaptive and closed-loop stimulation, emerging electrode technologies, and the future balance between innovation, scalability, and patient-centered care.Tune in for a thoughtful and wide-ranging conversation on precision, evidence, and humanity in brain stimulation — and on how functional neurosurgery continues to teach us how the brain truly works.