Deep brain stimulation (DBS) is recommended for medically refractory movement disorders, namely, Parkinson’s disease (PD),^{Reference de Bie, Katzenschlager and Swinnen1} essential tremor^{Reference Ferreira, Mestre and Lyons2} and dystonia. A Canada Drug Agency evaluation estimated an approximate annual rate of 650 implantation surgeries in pre-COVID-19 pandemic times, of which approximately 50% were done in Ontario.^{Reference Santos, Brett, MacDougall, Walter and Horton3} This figure is considered low in the face of the known epidemiology of movement disorders indications for DBS and highlights the problems of accessibility and capacity of this advanced therapy in Canada.^{Reference Harding, McFarlane, Honey, McDonald and Illes4}

In this issue of CJNS, the article “Mixed Methods Survey to Identify Barriers to Accessing Deep Brain Stimulation for Movement Disorders in Canada” evaluated the barriers and challenges in the care pathway for movement disorders DBS in Canada with a multiple stakeholder perspective that included neurosurgeons, neurologists and family physicians. Patients and care partners were also surveyed: the majority of the patient responders had not received DBS, allowing to have a less biased perspective on access in a patient-centric manner.

The study flagged poor access to DBS with reported waitlists of 2–5 years across Canada and an inadequate number of neurologist specialists or functional neurosurgeons. The problem of capacity that these results indicate is compounded by geographical location and socioeconomic status (but not ethnicity or gender) being important determinants of inequitable access to DBS. The poor understanding of indications for DBS was a key factor outlined by family physicians. Despite the study having been conducted in exceptional times of the COVID-19 pandemic and, more importantly, the existence of an imbalanced provincial representation in the study sample across participant stakeholders’ groups, these results are consistent with prior observations^{Reference Harding, McFarlane, Honey, McDonald and Illes4} and need to be valued for concrete actions.

Education for patients/care providers (and community providers), centralization/limitation of resources, patient factors and referral process were identified as the main themes undermining equitable access to care with DBS. Proposed solutions include the promotion of virtual care, the distribution of educational resources to increase knowledge on DBS indications for movement disorders and the implementation of regional referral pathways to effectively use Canada’s capacity for DBS at any point in time. Training of neurologist specialists/functional neurosurgeons is a necessary strategy with long-term impact to address current needs and an expected growing prevalence of PD.^{Reference Su, Cui and He5}

This study can be seen as an urgent call for advocacy of patient and professional organizations to change the landscape of DBS access in Canada and ensure that advanced therapies are available at the right time to the right movement disorders patients in 2025 and beyond.