Parkinson’s disease is a chronic, progressive, neurodegenerative disorder. It occurs most often in older patients and causes symptoms such as motor impairment, autonomic dysfunction, mood and cognitive impairment. Sequelae of Parkinson’s disease include decreased quality of life, loss of work capacity, and increased health care expenditures. With an aging society, it is conservatively estimated that the number of people with Parkinson’s disease worldwide will double by 2030, and the search for effective treatments for Parkinson’s disease is imminent. To date, drug therapy has been the most effective in relieving the motor symptoms of Parkinson’s disease, including resting tremor, bradykinesia and bradykinesia; levodopa remains the most effective first-line drug for the treatment of motor symptoms; the effective duration of this drug, or the “honeymoon period” as we call it, generally lasts for several years. In advanced Parkinson’s disease, as motor symptoms fluctuate, the duration of inability to exercise increases. The time of day when movement is not possible is gradually extended, and the time when movement is possible is affected by bradykinesia. Previous studies have recommended subthalamic nucleus (STN) neurostimulation for the treatment of dyskinesia and symptom fluctuations in patients with advanced Parkinson’s disease and severe motor complications. However, for many patients, it is too late to improve motor complications – the treatment does not improve cognitive impairment, which would offset the benefits of improved motor function. Dr. Schuepbach and colleagues evaluated the effects of neurostimulation combined with the most effective drug therapy for Parkinson’s disease and motor complications. In the current issue of the New England Journal of Medicine, the investigators report that neurostimulation combined with pharmacotherapy was superior to pharmacotherapy alone. The addition of hypothalamic stimulation to pharmacotherapy not only improved quality of life and mild levodopa-induced motor complications in patients with early Parkinson’s disease, but also reduced subsequent motor disability. Patient self-report and Parkinson’s disease-specific quality-of-life questionnaire results showed improved outcomes. In addition, patient logs documented increasing durations of good motor status, indicating improved motor function. The improved patient outcomes are strong evidence of the clinical value of neurostimulation. The specialists have improved the traditional approach to motor function and their clinical practice has demonstrated the benefits that neurostimulation can provide. This is one of the most rigorously executed neurostimulation trials. The investigators administered the drug via the body circulation based on well-defined evidence and were evaluated by an independent panel of experts. Although it is difficult to blind in neurostimulation studies, the reviewers do not have access to the experimental designer, but rather assess motor symptoms via videotape. Details of the methodology are available on the NEJM website, which may also provide a valid method for further experiments. There are warnings about the clinical application of this treatment. The patients enrolled in this study are not representative of the majority of patients with Parkinson’s disease. All patients enrolled were under 60 years of age at the time of surgery, in good general health, without dementia, and responding well to levodopa. Few patients with Parkinson’s met these criteria: only 11% of patients were under 60 years of age at the time of diagnosis of Parkinson’s disease, and an average of 30% of patients had comorbid dementia. It is unknown whether these results can be reproduced in an older population of Parkinson’s patients or whether they can be achieved in inexperienced medical centers. In addition, the study found an increase in suicidality in the neurostimulation group, although the group showed an improvement in assessed values for depression. Suicidal phenomena had been thought to be associated with hypothalamic stimulation, but other surgical treatment loci for Parkinson’s disease. The investigators were fully aware of the importance of the patient monitor and used it to systematically monitor patients for signs of suicide. Little is known about the long-term effects of neurostimulation. A small number of enrolled patients had fluctuating improvements in symptoms that lasted at least 10 years. This result suggests that it seems to be more effective in carefully selected, young patients with newly developed symptom fluctuations. Suicidal tendencies in postoperative patients will persist for several years, so continued careful monitoring of patients is required. The cost of neurostimulation is high, but the cost of surgery can be offset by a reduction in postoperative medication. The benefit of surgery also appears to depend on the experience of a large, multidisciplinary team of experts. Most importantly, neurostimulation is beneficial for only some patients with fluctuating symptoms who meet the criteria. The potential progression of Parkinson’s disease and the inevitable disability caused by other disease features have also failed to improve. Alternative treatments include neurostimulation of other sites, such as the pallidum bulb (globus pallidus), and also modifications to levodopa administration. In advanced Parkinson’s disease, stimulation of the pallidum may be similar to or slightly less effective than stimulation of the subthalamic nucleus. Continuous administration of dopaminergic therapy can produce side effects in terms of psychiatric symptoms or symptom fluctuations that diminish its benefit. None of these treatment modalities has been compared with subthalamic nucleus neurostimulation in an older population of patients with motor complications. The ideal treatment for Parkinson’s disease would improve not only motor function but also all symptoms of the disease. Subthalamic nucleus neurostimulation does not improve all symptoms, but it can prolong the duration of good function for several years in carefully selected, high-functioning status patients.