Pallidotomy for severe Parkinson's disease dyskinesia and other motor features in a resource-limited setting: the Philippine experience and review of the literature.

Levodopa-induced dyskinesia (LID) is a major complication of advanced Parkinson's disease (PD) and may limit optimal dopaminergic therapy. Although deep brain stimulation (DBS) is the standard surgical treatment for medically refractory motor complications, pallidotomy remains a relevant alternative in resource-limited settings where access to DBS is constrained. We report 2 Filipino women with PD who developed disabling, medically refractory LID and were not candidates for DBS because of financial limitations. Both underwent unilateral posteroventral pallidotomy (PVP) targeting the globus pallidus internus. In Case 1, left-sided PVP was associated with an estimated 50%-80% reduction in dyskinesia affecting the right extremities, with corresponding functional improvement, although standardized pre- and postoperative motor scores were not consistently documented. In Case 2, right-sided PVP was associated with an approximately 60% reduction in dyskinesia at 7 months, with improvement in bradykinesia and rigidity; total Unified Parkinson's Disease Rating Scale score improved from 71 preoperatively to 17 postoperatively. Both patients were discharged without adverse effects. Although DBS generally confers greater, more durable, and adjustable improvements in motor symptoms and levodopa-induced dyskinesia, our cases demonstrate that unilateral PVP remains capable of producing clinically meaningful reductions in both dyskinesia and motor disability. In settings where DBS is inaccessible or not feasible, pallidotomy continues to represent a relevant and practical therapeutic option for carefully selected patients. Moreover, the sustained benefit observed in both LID and overall Parkinson's disease motor symptoms further supports its role as an alternative to the current advanced treatment armamentarium.