1.Is surgical treatment of Parkinson’s better as early as possible, i.e., should it be chosen at an early stage of the disease? A: The perception that surgical treatment for Parkinson’s is the earlier the better and that surgery should be chosen at an early stage of the disease are both wrong. Parkinson’s disease is a complex neurological disease that used to have a high incidence over the age of 50, but is now gradually becoming younger. Therefore, the first and most important thing is to make an accurate diagnosis when Parkinson’s symptoms appear. The clinical diagnosis is still uneven in China, and many patients are easily misdiagnosed in the early stages. Parkinson’s disease and Parkinson’s syndrome are two types of diseases, the latter with poor surgical results; if the patient has an early age of onset, be sure to be alert to the possible line of Parkinson’s syndrome. Medication is needed in the early stage, and it can only be determined if other symptoms other than Parkinson’s disease (such as incontinence, balance disorder, dysphagia, sexual dysfunction, etc.) are still not present after 2-3 years. In the early stage of Parkinson’s disease, because the patient’s symptoms are mild, the symptoms improve significantly after taking the medication and the medication fluctuates little; as the disease progresses, the patient experiences significant medication fluctuations, i.e., the “on/off” phenomenon (on/off phenomenon, meaning that the patient’s symptoms fluctuate between remission (on period) and exacerbation (off period) throughout the day because of the medication). (the on/off phenomenon, which refers to the fluctuation of symptoms between remission (on period) and exacerbation (off period) throughout the day, may occur repeatedly and rapidly several times a day. At the same time, patients taking medication for a long time may also produce side effects of drugs such as allodynia and end-of-dose effects, and this stage may be the time to consider brain pacemaker therapy. 2, Parkinson’s drug treatment appears “end of dose” phenomenon, the emergence of “isokinetic” before considering surgery? A: When Parkinson’s disease progresses to the stage of progression, drug fluctuations, “end-of-dose” phenomenon, and anomalies occur, and it is impossible to correct these side effects by adjusting the medication, which seriously affects daily life, surgery can be considered at this time. 3.After several years of Parkinson’s drug treatment, the effect is no longer satisfactory, is surgery the only option? A: Parkinson’s disease (PD) is a clinically common progressive neurodegenerative disease with a prevalence of about 1% in people over 55 years of age, and there are more than two million people with PD in China. Drug therapy can only relieve the symptoms of PD, but cannot effectively control the progression of the disease, and long-term treatment may also cause side effects such as “on/off” phenomenon, dyskinesia, and psychiatric symptoms: many patients will eventually lose their ability to take care of themselves, causing a heavy economic burden to society, families, and the patients themselves. In the progressive stage of Parkinson’s disease, surgical treatment becomes the only means to relieve Parkinson’s symptoms and eliminate drug side effects. There are currently only two types of surgical treatment: disruption and implantation of a brain pacemaker (DBS). The disadvantage is that it can only be done on one side, which is irreversible and cannot be adjusted; the advantage of DBS is that it is reversible, adjustable, and can treat bilateral symptoms at the same time. 4.Is there an age limit for surgical treatment? How old is the patient will no longer be considered? A: Surgical treatment of Parkinson’s patients is generally better before the age of 70, because as age increases, the patient’s brain atrophy will be obvious, brain atrophy obvious patients will increase the difficulty of surgery and surgical risk. In addition, as age increases, the patient’s physical fitness decreases. As for how old the patient will not be considered for surgery, it also depends on the specific situation of the patient. 5.Does the younger the patient, the more priority is given to drug treatment? A: Both young and old patients with Parkinson’s disease should be considered for medication first. After a period of treatment, if the patient develops drug complications, surgery will be considered. There is no clear relationship between Parkinson’s disease and the age of onset. Younger patients with signs of Parkinson’s disease must be observed for about 3 years before a diagnosis of Parkinson’s syndrome can be made. Parkinson’s disease is very effective when treated with medication in its early stages, in both young and old patients. Doctors must first correctly diagnose Parkinson’s, and then make a reasonable treatment plan based on the patient’s disease duration. 6.What underlying diseases are patients not considered for surgery? A: There are no absolute contraindications to surgery for Parkinson’s disease. As long as the general condition of the body is well regulated and the underlying diseases (such as hypertension, diabetes and heart disease) are well controlled, surgery is possible. However, a clear diagnosis of primary Parkinson’s disease must be made. Aspirin should be stopped for two weeks before surgery. 7. For patients, is brain pacemaker implantation therapy a treatment to delay the disease and control the symptoms or a cure for the disease? A: The cause of Parkinson’s disease is still not fully understood, and all current treatments are symptomatic, but not curative. The vast majority of results after brain pacemaker implantation therapy (DBS) are very good, and the quality of life of patients is substantially improved. 8.Can I stop taking medication after the implantation of a brain pacemaker? A: The implantation of DBS can relieve patients from various complications caused by medication, such as “on/off” phenomenon, anisocoria, end-of-dose phenomenon, etc. After the surgery, the patient can usually achieve a good state with the previous medication without significant fluctuations. Patients still need to continue to take medication; however, the amount and type of medication taken will be reduced. Patients generally have the misconception that it is the surgery that completely solves the problem; in fact, Parkinson’s disease surgery does not completely solve the problem of lack of dopamine in the body. If the medication is completely stopped, weakness in the limbs and lack of energy may occur.