Infrathalamic ablation in advanced Parkinson's disease: Three-year outcomes support a safe and accessible therapeutic...

Advanced Parkinson's disease (PD) presents significant therapeutic challenges, especially in resource-limited settings. While deep brain stimulation (DBS) remains the gold standard, its accessibility is restricted. Infrathalamic stereotactic ablation has emerged as a promising alternative.

To evaluate the long-term clinical outcomes of combined stereotactic ablation targeting the caudal zona incerta and Fields of Forel in patients with advanced PD and a tremor-rigid phenotype.

A longitudinal study with 36-month follow-up was conducted in ten patients with unilateral, medication-refractory PD symptoms. Stereotactic radiofrequency lesions were applied, and motor outcomes were assessed using UPDRS-III in the medication "off" state at multiple time points.

Significant motor improvement was observed from baseline (55.0 ± 7.2) to 36 months (18.7 ± 4.6), with large effect sizes and sustained reductions in tremor, rigidity, bradykinesia, and gait impairment. No major complications occurred, and transient adverse effects resolved spontaneously.

Combined infrathalamic ablation offers sustained clinical benefits and an optimal safety profile, supporting its role as an effective and accessible treatment option for advanced PD in low- and middle-income contexts.