Over the years, I have met many patients and families facing the daily challenges of Parkinson’s disease. It is a condition that changes not only the patient’s life but also the lives of everyone who loves and cares for them. One of the most common questions I hear is: “When do we know that medicines are not enough? When should we think about surgery?”

Parkinson’s disease is a progressive neurodegenerative disorder. In the beginning, medications — especially those that replace or mimic dopamine — work very well to control symptoms like tremors, stiffness, and slowness of movement. But as time passes, medicines may start to lose their effect or cause side effects.

As I often explain to families, “All Parkinson’s disease patients don’t have Deep Brain Stimulation as the first line of treatment. They are all treated with medicines first. And once the medicines start losing their effect, or they develop complications, only then are they considered for surgery.”

So when is it time to think about surgery? Here are a few signs:

Medications Don’t Last Long Enough
In the early years, one tablet may control symptoms for hours. Later, the “on” time gets shorter and “off” times — when symptoms come back — become longer. If this “wearing off” becomes hard to manage with just dose adjustments, surgery may help.

 Uncontrolled Involuntary Movements
Long-term use of Parkinson’s medication can lead to unwanted jerky movements, called dyskinesias. If these movements make daily life difficult, surgery can help reduce them.

Symptoms Affect Quality of Life
When tremors, stiffness, or slowness interfere with eating, dressing, walking, or working  even with the best medical care  it’s worth discussing surgical options.

 Good Response to Medication
One important point is that surgery works best for patients whose symptoms improve with medication. As I tell patients, “It is like a pacemaker for the brain. The goal is not to cure Parkinson’s, but to break the abnormal signals causing symptoms.”

The most common surgical treatment today is Deep Brain Stimulation (DBS). This involves placing electrodes in specific areas deep inside the brain and connecting them to a small battery (similar to a pacemaker) implanted under the skin. The electrodes deliver mild electrical impulses that help control abnormal brain signals.

DBS is not a cure, but it can make a huge difference. “It is life-changing for these patients. There are people who could not even eat or walk because of severe tremors, and after surgery they can lead near-normal lives.”

Not every patient is a candidate for surgery. Careful selection is crucial. The best candidates are those under 70 years old, with good general health, who have a strong support system, and whose symptoms respond well to medication.

If you or your loved one is struggling with Parkinson’s despite optimal medication, I encourage you to talk to your neurologist about surgical options like DBS. With the right timing and the right team, surgery can help people with Parkinson’s live more independently and with better quality of life.

Remember, Parkinson’s care is always about teamwork — doctors, patients, and families working together to make each day better.