Bilateral Focused Ultrasound Pallidotomy for Parkinson‐Related Facial Dyskinesia—A Case Report

BACKGROUND: For safety reasons, both magnetic resonance‐guided high‐intensity focused ultrasound (MRgHiFUS) thalamotomy and pallidotomy are currently approved exclusively for unilateral treatment, but axial symptoms like levodopa‐induced orofacial dyskinesia require a bilateral approach. OBJECTIVES: We report the first case of successful bilateral MRgHiFUS pallidotomy for peak‐dose dyskinesia in a patient with Parkinson's disease (PD). METHODS: The treatment decision was based on the patient's reluctance toward brain implants and pump therapies and the fact that he had limited access to a deep brain stimulation center in his home country. The treatment was planned as staged procedure with an interval of 18 months because of travel restrictions because of the coronavirus disease (COVID)‐19 pandemic. RESULTS: After the second treatment, levodopa‐induced orofacial dyskinesia remitted and improved bradykinesia and rigidity with stable gait and good postural reflexes. CONCLUSIONS: This promising result suggests that in selected PD patients with dyskinesia, staged bilateral MRgHiFUS pallidotomy might be considered.