Gamma Knife Thalamotomy for Disabling Tremor

Okun et al¹ report complications in 8 patients who had gamma knife radiosurgery for Parkinson disease. All of these patients were treated in a single center. Although the authors carefully report their clinical outcomes, several points made in their article should be addressed and clarified. Their abstract begins with the following statement: "Many medical centers throughout the world offer radiosurgery with the gamma knife (GK) for pallidotomy and thalamotomy as a safe and effective alternative to radiofrequency ablative surgery and deep brain stimulation for Parkinson disease." I do not believe that this is correct. Many medical centers with a gamma knife do not offer this treatment; most use it to treat brain tumors or vascular malformations. Movement disorders are usually treated only by people experienced in performing surgery for this type of condition. This is an infrequent procedure relative to others. Most medical centers with a gamma knife do not perform thalamotomy or pallidotomy.