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To: P.I.E.N. 1. Pause for a moment and consider how quickly therapies have advanced in the past decade. Pallidotomy had not eve been rediscovered ten years ago. DBS was a gleam in Alain Benabid's eye. I was the first North American patient to have DBS on 12.14.94, not even five years ago. 2. My speculation is, and I would be interested in Charlie, Chris and Bob's reaction, that DBS works in two separate and distinct ways: i) the actual insertion of the electrode in the GPI/STN moves the brain cells sufficiently to cause the circuitry to be altered; and ii) chronic stimulation is ‘the icing on the cake' and multiplies synergistically the effect of the electrode 3. This is why the placement of the electrode must be made with such precision and why some patients have less successful results than others 4. This is all highly speculative because we only know that DBS works; we know neither how nor why it works 5. PWPs who have neurosurgery must recognize the point in 4 above and the fact that we do not know what the long term risks are Bill