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Deep brain stimulation (DBS) has recently been proven to be an effective therapy for medication-refractory symptoms of Parkinson’s disease. As the evidence base continues to evolve, many important issues have surfaced, including: what operation should be performed (brain target[s], unilateral vs bilateral, simultaneous vs staged); when to operate (how early is too early to intervene?), who should be operated on (disease duration, age, symptom profiles and the use of the interdisciplinary screening team); and finally, why to operate (the rationale of surgery vs medication/apomorphine pumps/duodopa pumps/stem cell trials/gene therapy trials). We will address each of these critical issues, as well make the argument that a tailored approach to DBS and DBS targeting will best serve each potential candidate. We will review the multiple peer-reviewed studies and we will emphasize the recently available data from …