Despite being available for more than 25 years, deep brain stimulation (DBS) has been underutilized globally, with studies citing similar barriers to access to the ones found by Lannon et al.^{Reference Wagle Shukla, Deeb, Patel and Ramirez-Zamora1} DBS is offered in 15 centers in Canada, typically involving a multidisciplinary team consisting of neurologists, neurosurgeons, nurses and neuropsychologists. Although the array of assessments appears burdensome, it is crucial for candidacy and safety.

Virtual care is encouraged to minimize barriers for individuals distant from DBS centers. Neurology and neurosurgery visits, neuropsychological assessments,^{Reference Sarno, Buré-Reyes and Harcourt2} levodopa challenge tests^{Reference Zeng, Lin and Chen3} and device programming have been successfully performed virtually.^{Reference Fung, Justich and Hamani4}

However, accessibility to DBS centers is only part of the solution. People with movement disorders need to receive an accurate diagnosis and management earlier in their disease, and yes, optimal management still consists of a combination of pharmacological treatment, rehabilitation and lifestyle interventions and compassionate care. Family physicians can manage this in the early stages, but a referral to neurology may be necessary when any complexity arises.

The Extension for Community Healthcare Outcomes (ECHO)^{Reference Neilson, Wilhelm, McDonnell, Mann and Kraakevik5} is a broadly applicable framework for delivering specialized care to patients with chronic, complex diseases in underserved communities. This initiative, along with similar ones, establishes telementoring networks, empowering remote physicians to manage their patients. The ECHO epilepsy program in Ontario serves as a compelling example in Canada.

Family physicians and general neurologists can employ various tools to facilitate timely referrals of Parkinson’s disease patients to DBS centers, with the 5-2-1 criteria^{Reference Borovečki, Perković, Kovacs, LeWitt, Bar and Katzenschlager6} being the most commonly used. Although these tools are imperfect, they can provide a basic framework, allowing non-specialists to initiate discussions with their patients without missing the time for adequate intervention.

Clinicians should keep a low threshold for referring patients to a movement disorder center, ensuring that patients have the opportunity to be fully considered not only for DBS but also for other device-aided therapies, such as subcutaneous infusion of foslevodopa or levodopa carbidopa intestinal gel. In people with essential tremor, MRI-guided focused ultrasound offers an alternative to DBS, involving much less complex postoperative follow-up, overcoming some of the perceived barriers to DBS. In patients with dystonia, the referral threshold should be even lower, as specialized investigation and management with botulinum toxin may be indicated.

Ultimately, patients with movement disorders and their families need to be well-informed regarding available options and empowered to express their preferences and values at earlier stages. Patient advocacy groups can play a valuable role in this process, but a good physician–patient relationship and strong communication remain paramount at every stage of care.