**5. Conclusions**

The number of DBS surgeries continues to increase, as indications expand and the population is aging. Currently, STN DBS surgery is performed in various ways with or without MER under LA or GA in each center. Based on the reports of previously published studies and ours, it is likely that GA does not interfere with the MER signal from STN. In addition, STN DBS under GA without intraoperative stimulation shows similar or better clinical outcome without any additional complication compared to STN DBS under LA. Although there are various pros and cons of each method in each protocol in each protocol of STN DBS under LA and under GA, the stereotype that STN DBS surgery must be performed under LA to perform intraoperative macrostimulation and MER to obtain the best clinical outcome should be changed at the moment.

In conclusion, it is suggested that, if there is no significant di fference in clinical treatment e ffects and complications between GA and LA, it would be reasonable to implement STN DBS under GA because it can minimize unnecessary inconvenience of the patients with PD. Long-term follow-up studies with the large number of the patients would be necessary to further validate the safety and efficacy of STN DBS under GA.

**Author Contributions:** Conceptualization, S.H.P. and B.J.; methodology, H.-J.K.; software, Y.H.L.; validation, W.-W.L., K.H.P. and K.P.; formal analysis, H.R.P.; investigation, E.J.S.; resources, J.M.L.; data curation, Y.H.L.; writing—original draft preparation, H.R.P. and S.H.P.; writing—review and editing, H.R.P., B.J. and S.H.P.; visualization, H.-J.K.; supervision, B.J.; project administration, S.H.P.; funding acquisition, H.R.P. and S.H.P. All authors have read and agreed to the published version of the manuscript.

**Funding:** This study was funded by the Korea Healthcare Technology R&D Project (grant HI11C21100200, HI18C0886), funded by the Ministry of Health & Welfare, Republic of Korea; the Industrial Strategic Technology Development Program (grant 10050154, Business Model Development for Personalized Medicine Based on Integrated Genome and Clinical Information) funded by the Ministry of Trade, Industry & Energy (MI, Korea); the Original Technology Research Program for Brain Science through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (grant 2015M3C7A1028926, 2017M3C7A1044367); the Original Technology Research Program for Brain Science through the NRF funded by the Ministry of Education, Science and Technology (2017M3C7A1047392); Basic Science Research Program through the NRF funded by the Ministry of Education (NRF-2017R1D1A1B03035556); and Soonchunhyang University Research Fund (2020).

**Acknowledgments:** Yona Kim contributed to this work by English proofreading.

**Conflicts of Interest:** The authors declare no conflict of interest.
