Safety and efficacy of staged radiofrequency bilateral thalamotomy or pallidotomy in the treatment of Parkinson’s disease

Abstract Background Parkinson’s disease is a progressive neurodegenerative disorder characterized by both motor and non-motor manifestations. Although pharmacological therapies remain the mainstay of treatment, their long-term efficacy is often limited and may be associated with significant adverse effects. Consequently, there is increasing interest in surgical interventions such as radiofrequency pallidotomy and thalamotomy as alternative therapeutic options. This study aimed to assess the safety and efficacy of the clinical outcomes of staged bilateral thalamotomy and/or pallidotomy performed at intervals of six to eight months in patients with Parkinson’s disease, based on both prospective and retrospective data. Results The mean age of the cohort was 55.5 years, with a mean disease duration of 5.9 years; 66.7% of the participants were male. Thalamotomy was performed in 60% of patients with tremor-dominant Parkinson’s disease, whereas pallidotomy was carried out in 40% of patients with rigidity-dominant symptoms. Both procedures resulted in significant improvements in motor function, as assessed by Part III of the Unified Parkinson’s Disease Rating Scale. At six months, thalamotomy achieved approximately a 45% improvement, while pallidotomy resulted in a 60% improvement; both effects were sustained for up to 36 months. Tremor completely resolved in 77.8% of patients who underwent thalamotomy, and rigidity improved in 83.3% of patients who underwent pallidotomy. In addition, improvements in gait and speech were observed. Conclusion Staged bilateral radiofrequency thalamotomy and pallidotomy appear to be safe and effective surgical options for carefully selected patients with Parkinson’s disease, resulting in sustained improvements in motor symptoms, gait, and speech over 36 months. Favorable outcomes may be attributed to careful patient selection and motor subtype–guided targeting. The procedures were associated with only minor transient complications and may represent a cost-effective alternative or adjunct to deep brain stimulation. Despite the small sample size, these findings support the continued clinical value of staged bilateral RF lesioning in functional neurosurgery.