{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T18:04:11Z","timestamp":1780509851966,"version":"3.54.1"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Advanced Parkinson\u2019s disease (PD) with a tremor\u2013rigid phenotype poses therapeutic challenges when pharmacological treatments lose efficacy and deep brain stimulation (DBS) is not an option; particularly in contexts where access to implantable neuromodulation therapies is limited. In this scenario, stereotactic ablation of the caudal zona incerta (cZI) and the Fields of Forel has emerged as a surgical alternative, although long-term evidence remains scarce, especially for combined infrathalamic approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A prospective study was conducted in 10 patients with advanced unilateral PD and a tremor-rigid phenotype, treated with stereotactic radiofrequency in the cZI and Fields of Forel. Motor function was assessed using the UPDRS III at six time points (baseline, 3, 6, 12, 24, and 36\u202fmonths), allowing the analysis of both early response and long-term clinical stability. Paired Student\u2019s\n                      <jats:italic>t<\/jats:italic>\n                      -tests were applied to compare longitudinal changes in UPDRS III between baseline and follow-up assessments. In addition, effect sizes were calculated using Cohen\u2019s d.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      UPDRS III scores were significantly reduced at all follow-ups (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), with mean decreases of \u221225.8 points at 3\u202fmonths and \u221236.3 points at 36\u202fmonths. Effect sizes were very large (d\u202f&amp;gt;\u202f4.0). Tremor improved early and was sustained; rigidity and bradykinesia showed marked reductions during the first year with a slight subsequent upward trend; gait demonstrated continuous progression up to 36\u202fmonths. No major complications were recorded, and transient adverse effects were minimal, consisting of mild and transient postoperative imbalance in two patients, with rapid clinical recovery and no permanent sequelae.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Stereotactic ablation of the cZI and Fields of Forel provides robust and sustained clinical benefits at 3 years, with a favourable safety profile. These findings highlight the durability of the motor effect of infrathalamic ablative approaches and position this technique as a viable alternative to DBS in selected patients with advanced PD; underscoring the need for multicentre studies to consolidate its role in contemporary functional surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnagi.2026.1756591","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T06:37:11Z","timestamp":1774593431000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Long-term outcomes after caudal zona incerta-forel field ablation: three-year clinical follow-up in advanced Parkinson\u2019s disease"],"prefix":"10.3389","volume":"18","author":[{"given":"Boris","family":"Zurita-Cueva","sequence":"first","affiliation":[{"name":"Departament of Neurosurgery, Omni Hospital Guayaquil","place":["Guayaquil, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Vaca-Burbano","sequence":"additional","affiliation":[{"name":"Hospital de la Polic\u00eda Nacional","place":["Guayaquil, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cleto","family":"Ram\u00edrez-Penso","sequence":"additional","affiliation":[{"name":"Servicio de Neurocirug\u00eda, Centro Cardio-Neuro-Oftalmol\u00f3gico y Trasplante (CECANOT)","place":["Santo Domingo, Dominican Republic"]},{"name":"Sociedad Dominicana de Neurolog\u00eda y Neurocirug\u00eda (SDNN)","place":["Santo Domingo, Dominican Republic"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauricio","family":"Navarrete-Carre\u00f1o","sequence":"additional","affiliation":[{"name":"Neuroloop Medical Center","place":["Guayaquil, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andris","family":"Mej\u00eda","sequence":"additional","affiliation":[{"name":"Universidad Central del Este","place":["San Pedro de Macor\u00eds, Dominican Republic"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan-Carlos","family":"Coronado","sequence":"additional","affiliation":[{"name":"Departamento de Procesos Terap\u00e9uticos, Facultad de Ciencias de la Salud, Universidad Cat\u00f3lica de Temuco","place":["Temuco, Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Breiner","family":"Morales-Asencio","sequence":"additional","affiliation":[{"name":"Consorcio Latinoamericano de Investigaci\u00f3n (Clati)","place":["Temuco, Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Sald\u00edas","sequence":"additional","affiliation":[{"name":"Escuela de Kinesiolog\u00eda, Facultad de Salud, Universidad Santo Tomas","place":["Temuco, Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norman","family":"L\u00f3pez","sequence":"additional","affiliation":[{"name":"Escuela de Kinesiolog\u00eda, Facultad de Salud, Universidad Santo Tomas","place":["Temuco, Chile"]},{"name":"Departamento de Ciencias Sociales, Universidad de la Costa","place":["Barranquilla, Colombia"]},{"name":"Centro de Investigaci\u00f3n en Prevenci\u00f3n y Cuidados de la Salud (+SALUD), Facultad de Salud, Universidad Santo Tom\u00e1s","place":["Santiago, Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2615","DOI":"10.1101\/2024.05.09.593398","article-title":"Prediction of pathological subthalamic nucleus beta burst occurrence in Parkinson\u2019s disease","volume":"40","author":"Abdi-Sargezeh","year":"2024","journal-title":"Mov. 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