{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T13:00:25Z","timestamp":1772283625259,"version":"3.50.1"},"reference-count":27,"publisher":"IMR Press","issue":"2","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Neurol."],"abstract":"<jats:p>Background: Unilateral microelectrode-guided pallidotomy has re-emerged as a therapeutic option for advanced Parkinson's disease (PD), particularly in resource-limited settings. This study evaluated motor and neuropsychological outcomes following radiofrequency ablation of the internal globus pallidus (GPi) using image fusion and intraoperative microelectrode recording. To assess the motor efficacy, cognitive impact, and safety profile of unilateral GPi pallidotomy guided by neurophysiological monitoring in patients with advanced idiopathic PD of the rigid-akinetic subtype. Methods: This retrospective, single-center, observational case series included 12 patients with advanced PD who underwent unilateral radiofrequency pallidotomy targeting the internal segment of the GPi. Movement Disorder Society\u2013Unified PD Rating Scale Part III (MDS-UPDRS-III), including both contralateral and ipsilateral domain sub scores. Levodopa-induced dyskinesias (UPDRS-IV) and cognitive performance (NEUROPSI Attention and Memory battery) were also assessed before and 12 months after surgery. Statistical analyses were conducted using paired t-tests or Wilcoxon signed-rank tests depending on data distribution, with significance set at p &lt; 0.05. Results: At 12-month follow-up, motor outcomes improved significantly. Mean MDS-UPDRS-III scores decreased from 64.1 \u00b1 27.1 preoperatively (OFF medication) to 37.8 \u00b1 24.4 postoperatively, and from 23.5 \u00b1 17.0 to 10.6 \u00b1 8.5 in the ON state. The overall OFF-state improvement was 44.4% \u00b1 21.2%. Paired t-tests confirmed a highly significant reduction in motor scores (t = 6.19, p &lt; 0.0001; mean change \u201326.3 points, 95% confidence intervals (CI) \u201334.7 to \u201318.0). Domain-specific analysis showed significant contralateral improvements in rigidity (\u201348%, p = 0.0006), bradykinesia (\u201349.5%, p &lt; 0.0001), resting tremor (\u201381%, p = 0.004), gait (\u201327.8%, p = 0.013), postural stability (\u201339%, p = 0.021), and dyskinesias (\u201356%, p = 0.017). Ipsilateral changes were mild and not statistically significant for rigidity (\u201314.6%, p = 0.519), bradykinesia (\u201325.0%, p = 0.084), or rest tremor (\u201350.0%, p = 0.121). No major surgical complications occurred. Neuropsychological assessment revealed modest postoperative gains in executive functioning and working memory, with preservation of global cognition. Conclusion: Unilateral GPi pallidotomy guided by imaging and microelectrode recording is a safe and effective procedure that significantly improves motor symptoms while preserving cognitive function in appropriately selected patients with advanced PD, as demonstrated in our Guatemalan cohort.<\/jats:p>","DOI":"10.31083\/rn44171","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T12:11:13Z","timestamp":1772280673000},"source":"Crossref","is-referenced-by-count":0,"title":["Unilateral Microelectrode Recording\u2013Guided Pallidotomy in Advanced Parkinson's Disease: Clinical and Neuropsychological Outcomes in a Guatemalan Cohort"],"prefix":"10.31083","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7943-1205","authenticated-orcid":true,"given":"Juan Carlos","family":"Lara-Gir\u00f3n","sequence":"first","affiliation":[{"name":"Neurosciences Department, Humana Center for Epilepsy and Functional Neurosurgery Center, 01010 Guatemala City, Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9766-2382","authenticated-orcid":true,"given":"Diego","family":"S\u00e1nchez-D\u00edaz","sequence":"additional","affiliation":[{"name":"Neurosciences Department, Humana Center for Epilepsy and Functional Neurosurgery Center, 01010 Guatemala City, Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2430-6165","authenticated-orcid":true,"given":"Abel Alejandro","family":"Sanabria-Sanchinel","sequence":"additional","affiliation":[{"name":"Neurosciences Department, Humana Center for Epilepsy and Functional Neurosurgery Center, 01010 Guatemala City, Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3354-9054","authenticated-orcid":true,"given":"Edwin Stanly","family":"Escobar-Pineda","sequence":"additional","affiliation":[{"name":"Neurosciences Department, Humana Center for Epilepsy and Functional Neurosurgery Center, 01010 Guatemala City, Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7765-1280","authenticated-orcid":true,"given":"Manuel","family":"Hern\u00e1ndez-Salazar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u201c20 de Noviembre\u201d National Medical Center, Institute for Social Security and Services for State Workers (ISSSTE), 03104 Mexico City, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2467-9384","authenticated-orcid":true,"given":"Marco","family":"D\u00edaz","sequence":"additional","affiliation":[{"name":"Neurosciences Department, Humana Center for Epilepsy and Functional Neurosurgery Center, 01010 Guatemala City, Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3697-0041","authenticated-orcid":true,"given":"V\u00edctor","family":"Pineda","sequence":"additional","affiliation":[{"name":"Neurosciences Department, Humana Center for Epilepsy and Functional Neurosurgery Center, 01010 Guatemala City, Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7068-9970","authenticated-orcid":true,"given":"Williams","family":"Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Neurosciences Department, Humana Center for Epilepsy and Functional Neurosurgery Center, 01010 Guatemala City, Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6446-7511","authenticated-orcid":true,"given":"Ra\u00fal","family":"Cardona","sequence":"additional","affiliation":[{"name":"Neurosciences Department, Humana Center for Epilepsy and Functional Neurosurgery Center, 01010 Guatemala City, Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5890-3207","authenticated-orcid":true,"given":"Zoe Mar\u00eda","family":"G\u00f3mez","sequence":"additional","affiliation":[{"name":"Neurosciences Department, Humana Center for Epilepsy and Functional Neurosurgery Center, 01010 Guatemala City, Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"16242","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Simon DK, Tanner CM, Brundin P. 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Medicina Clinica. 2000; 114: 205\u2013208.","DOI":"10.1016\/S0025-7753(00)71245-0"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Fine J, Duff J, Chen R, Chir B, Hutchison W, Lozano AM, et al. Long-term follow-up of unilateral pallidotomy in advanced Parkinson\u2019s disease. The New England Journal of Medicine. 2000; 342: 1708\u20131714.","DOI":"10.1056\/NEJM200006083422304"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Vitek JL, Bakay RAE, Freeman A, Evatt M, Green J, McDonald W, et al. Randomized trial of pallidotomy versus medical therapy for Parkinson\u2019s disease. Annals of Neurology. 2003; 53: 558\u2013569.","DOI":"10.1002\/ana.10517"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Lachenmayer ML, M\u00fcrset M, Antih N, Debove I, Muellner J, Bompart M, et al. Subthalamic and pallidal deep brain stimulation for Parkinson\u2019s disease-meta-analysis of outcomes. NPJ Parkinson\u2019s Disease. 2021; 7: 77.","DOI":"10.1038\/s41531-021-00223-5"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Odekerken VJJ, van Laar T, Staal MJ, Mosch A, Hoffmann CFE, Nijssen PCG, et al. Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson\u2019s disease (NSTAPS study): a randomised controlled trial. The Lancet. Neurology. 2013; 12: 37\u201344.","DOI":"10.1016\/S1474-4422(12)70264-8"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Reese R, Koeglsperger T, Schrader C, T\u00f6nges L, Deuschl G, K\u00fchn AA, et al. Invasive therapies for Parkinson\u2019s disease: an adapted excerpt from the guidelines of the German Society of Neurology. Journal of Neurology. 2025; 272: 219.","DOI":"10.1007\/s00415-025-12915-6"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Abbas A, Hassan MA, Shaheen RS, Hussein A, Moawad MHED, Meshref M, et al. 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(In Chinese)"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Eskandar EN, Shinobu LA, Penney JB, Jr, Cosgrove GR, Counihan TJ. Stereotactic pallidotomy performed without using microelectrode guidance in patients with Parkinson\u2019s disease: surgical technique and 2-year results. Journal of Neurosurgery. 2000; 92: 375\u2013383.","DOI":"10.3171\/jns.2000.92.3.0375"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Krauss JK, Wolff Fernandes F. Svennilson\u2019s Publication on Pallidotomy for Parkinsonism in 1960: A Most Influential Paper in the Field. 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