In my daily outpatient or telephone consultations, I am often asked by Parkinson’s patients: “Doctor, when do you think I should have surgery?” In fact, to answer this question, the doctor needs a thorough and careful physical examination of the patient, in addition to a comprehensive medical history, in order to give an accurate recommendation. Therefore, it is best for the patient to be able to come to the hospital for an outpatient consultation. If the patient himself can grasp some medical knowledge, he can also make a self-judgment before the consultation. In the following, I will give some criteria for the patient to make a preliminary judgment and to have an idea of what to expect. First, in general, the indications for deep brain stimulation (DBS) 1. primary Parkinson’s disease (PD); 2. taking compound levodopa (methyldopa or xylazine) had good efficacy; 3. the efficacy has significantly decreased or there are severe motor fluctuations or isokinetic disorders that affect the quality of life; 4. no dementia and serious mental illness. Second, then, a little analysis of the details of patient selection 1, diagnosis: (1) meet the diagnostic criteria of primary PD; (2) hereditary PD or various genotypes of PD, as long as they respond well to compound levodopa, can also be operated. This point needs to be diagnosed by a specialist, so it will not be repeated. 2. Course of disease: The course of disease is also one of the indicators to decide whether to operate. Since patients with early PD respond well to medication, it is not recommended that they receive early DBS therapy. In addition, Parkinson’s superimposed syndrome such as multisystem atrophy (40%) and progressive supranuclear palsy (20%), which have symptoms similar to PD in the early stage of the disease and can respond well to compound levodopa preparations, are also not recommended to receive DBS therapy too early. Therefore, it is now usually recommended to consider surgery for patients who meet the following disease course conditions (1) the disease is more than 5 years old; (2) patients with confirmed primary Parkinson’s disease (PD) with predominantly tremor and unsatisfactory improvement of tremor by standard drug therapy, and tremor seriously affects the patient’s quality of life, if the patient strongly requests early surgery to improve the symptoms, it can be relaxed after evaluation to the disease duration of more than 3 years. 3. Age: (1) Patients should be no older than 75 years old; (2) Elderly patients may be relaxed to about 80 years old after individualized assessment of benefit and risk; (3) Elderly patients with predominantly severe tremor may have their age limit relaxed appropriately. Age is not a decisive factor, and a thorough clinical evaluation is required to determine whether surgery is an option. 4. Medication use: (1) had good efficacy with compounded levodopa; (2) had been optimally treated with medication (adequate dose, at least compounded levodopa and dopamine agonist); (3) were currently unsatisfied with medication for symptom control, had significantly decreased medication efficacy or had developed difficult motor complications. With regard to unsatisfactory drug efficacy and motor complications, these include, specifically, the following (1) severe end-of-dose phenomena and symptom fluctuations (drug intervals of only 2-3 hours and off periods of more than 6 hours in the awakening period) (2) presence of on-off phenomena (unpredictable motor fluctuations, unrelated to drug administration) (3) allodynia (peak-dose allodynia and biphasic allodynia) (4) painful dystonia (5) drug Refractory tremor 5. Severity of disease: Off stage Hoehn – Yahr 2, 5 to 4 stages. The method of staging is as follows: (1) Stage 0: asymptomatic. (2) Stage 1: Unilateral/side of the body is affected, but no effect on balance. (3) Stage 1 and 5: The body is affected unilaterally and affects balance. (4) Stage 2: The body is affected bilaterally/laterally, but does not affect balance. (5) Stages 2 and 5: The body is affected bilaterally/laterally, but balance can be restored on its own under the pulling (backward pulling) test. (6) Stage 3: Balance is affected, with mild to moderate disease. However, the patient can live independently. (7) Stage 4: Severe immobility. However, patients can walk and stand on their own. (8) Stage 5: Confined to bed or wheelchair without the help of others. Deep brain electrical stimulation (DBS), also known as pacemaker implantation, is based on the principle of high-frequency electrical stimulation by electrodes implanted in the brain to the relevant nuclei that control movement (medial pallidum – GPi, thalamus nucleus – STN, etc.). The electrical stimulation signal interferes with the abnormal neuroelectrical activity and restores the motor control loops or disordered neurotransmitters to a relatively normal functional state, thereby reducing the symptoms of motor disorders and improving the quality of life of patients. The pioneer of brain pacemaker therapy, Professor A. L. Benabid of France, has said, “In the next decade, brain pacemakers will profoundly influence our concept of treatment and advance our understanding and treatment of neurological diseases, especially degenerative neurological diseases.” In this regard, specialists in neurosurgery are deeply convinced. The installation of a brain pacemaker is a new milestone in the treatment of Parkinson’s disease. the DBS procedure is a minimally invasive neurosurgical procedure with small intraoperative incisions, low bleeding and fast postoperative recovery, while the brain pacemaker is a set of sophisticated microelectronic devices consisting of a pulse generator, electrodes and extension leads, all of which are implanted in the body and do not affect normal life. Therefore, the safety of this procedure has gradually gained widespread attention and recognition. In addition, due to its high efficiency of treatment and reversible, adjustable and low complications, more than 100,000 people worldwide have been treated with DBS surgery.