The role of pallidotomy in the precision medicine era

RP emerges as a feasible rescue-therapy for severe medically refractory SD. Most patients show meaningful short-term improvement, but beneficial effects tend to decline over time, with high rate of SD recurrence-particularly in dyskinetic-CP. This may reflect suboptimal lesions' location and/or size, progressive disease course or re-emergence of dystonia through different networks. In this light, RP should be considered when DBS is contraindicated, the risk of hardware-related complications outweighs the advantages of an adjustable system, or in patients with limited life expectancy, where an irreversible yet effective rescue intervention is clinically justified.