Q: Which Parkinson’s patients are suitable for the installation of a brain pacemaker? Drs.: Once the diagnosis of Parkinson’s is clear and after a period of medication, when side effects or ineffectiveness of medication occur, a brain pacemaker can be considered. Q: In what cases is a pacemaker not suitable? Drs.: There are two types of situations that are not suitable for the installation of a brain pacemaker. One is when the patient cannot tolerate the surgery during the evaluation of the safety of the surgery; on the other hand, those patients who cannot cooperate well after the surgery and the brain pacemaker cannot work properly, for example, postoperative regulation is very critical, but if the patient has cognitive impairment or is too physically weak to tolerate the postoperative regulation, the surgery is not suitable. Q: Are some Parkinson’s patients who have some non-motor symptoms such as anxiety or depression, or who are in poor psychological condition due to fear of surgery, still suitable for a brain pacemaker? Drs.: More than 90% of Parkinson’s patients are accompanied by some degree of depression and anxiety. Moreover, almost everyone is psychologically afraid and anxious when facing surgery. If these psychological changes do not have much effect on the surgical procedure and the post-operative neuromodulation, surgery is possible. If the patient’s psychological condition is very bad, even with hallucinations and cognitive impairment, surgical treatment is not recommended. Instead, the patient should be treated in a psychiatric department first, and only after the condition is stabilized and the patient is able to cooperate with the surgery and the postoperative regulation should a brain pacemaker be considered. When she came to our hospital, her motor symptoms were very severe and her medication was not well controlled, which affected her eating and walking. However, the patient also had severe hallucinations, saying that she often “saw” people walking around or that people came to hit her. In this case, we suggested the patient to go to the neuropsychology department to adjust her psychological state. After 2 to 3 weeks of treatment, the patient’s hallucinations gradually subsided, and then she went home to recuperate for 3 to 4 months. After her mental and psychological condition improved, she came back to the neurosurgery department for evaluation and surgery, and the postoperative results were excellent. Q: Can some patients who have had a disfiguring surgery still have a brain pacemaker installed? Doctor: This is something that needs to be evaluated, and the decision is based on the extent of the disfigurement. If the disruption is large and affects the function of the entire nucleus accumbens, it is not recommended to install a pacemaker. However, if the patient has lesions bilaterally, but only a large destruction of one side of the brain is done, then a pacemaker can be installed on the other side. If the destruction of the nucleus accumbens is small and the symptoms reappear 2 to 3 months after surgery, then a pacemaker can still be considered. Q: Will the results be affected if a pacemaker is implanted after a disruption? Doctor: Yes, it will be affected. After the disruption surgery, the patient’s nucleus accumbens is damaged and the other parts of the brain will be affected as well; after the pacemaker is installed, the effectiveness of the pacemaker will also be affected. Q: How do you determine if a patient is suitable for surgery? Drs.: The preoperative evaluation of the hospital for the installation of a pacemaker includes the following aspects: 1. safety assessment of the surgery, which is mainly done by the anesthesiology department to see if the patient can tolerate the surgical procedure and the anesthesia. 2. 2. The prediction of surgical efficacy, including the patient’s response to dopamine drugs, which is usually done by dopamine test. 3.Psychological assessment, mainly to see whether the patient’s psychological state can cooperate with the surgical procedure and postoperative regulation. 4, cognitive behavior assessment, which is mainly due to the fact that generally 20% of Parkinson’s patients will end up with dementia, if the patient has already developed dementia, surgery is not recommended.