In “Clinical outcomes of asleep vs awake deep brain stimulation for Parkinson disease,” authors Brodsky et al. aimed to compare motor and nonmotor outcomes at 6 months of asleep deep brain stimulation (DBS) for Parkinson disease (PD) using intraoperative imaging guidance to confirm electrode placement vs awake DBS using microelectrode recording to confirm electrode placement. They found that asleep DBS for PD was associated with improved motor outcomes over 6 months, on par with, or better than, awake DBS, and was superior with regard to speech fluency and quality of life. In the accompanying editorial, Drs. Aziz and Hariz point out that microelectrode recording (MER) should be reserved as a tool for scientific research on basal ganglia neuronal activity. The authors explain that well-visualized targets, such as the subthalamic nucleus and internal globus pallidus (GPi), can also be done while the patient is fully asleep and without MER. Commenting on the Brodsky et al. article, Dr. Sidiropoulos requests comparison between image-guided DBS surgery and MER-guided surgery and questions why the asleep group was more shifted towards GPi as a target compared to the awake cohort. Commenting on the editorial, Dr. Sidiropoulos also suggests that accurate thalamic targeting for tremor using image-guided techniques is more challenging. Dr. Aziz, author of the editorial, agrees that the subdivisions of the thalamus are not so clearly visualized. He explains, however, that using image-guided approaches is emerging and thalamic targets can be extrapolated from visualization of the red nucleus and the posterior subthalamic area. Dr. Troster also commented on the article. He asks for several clarifications regarding verbal fluency scores data, correlation between verbal fluency scores and 39-item Parkinson's Disease Questionnaire (PDQ-39) cognition and communication scores, and the effect on the Dementia Rating Scale (DRS). Brodsky et al. explain that Controlled Oral Word Association Test (COWAT) standard scores were used and that the longitudinal mixed-effects models were evaluated and confirmed previous findings. They clarify that statistical analysis of the correlation between the COWAT speech fluency scores and the cognition and communication subscores of the PDQ-39 was not performed, but that the improvement in both cohorts was significant. Finally, they explain that while the DRS is influenced by speech fluency, there were enough other factors in the DRS that counterbalanced the improvement in speech that was seen in the asleep DBS group. In “Clinical outcomes of asleep vs awake deep brain stimulation for Parkinson disease,” authors Brodsky et al. aimed to compare motor and nonmotor outcomes at 6 months of asleep deep brain stimulation (DBS) for Parkinson disease (PD) using intraoperative imaging guidance to confirm electrode placement vs awake DBS using microelectrode recording to confirm electrode placement. They found that asleep DBS for PD was associated with improved motor outcomes over 6 months, on par with, or better than, awake DBS, and was superior with regard to speech fluency and quality of life.