New insights from a Malaysian real-world deep brain stimulation cohort

• Published in: Journal of Parkinson's disease 2024-12
• Main Authors: Dy Closas, Alfand Marl F., Tan, Ai Huey, Tay, Yi Wen, Hor, Jia Wei, Toh, Tzi Shin, Lim, Jia Lun, Lew, Choey Yee, Cham, Chun Yoong, Yim, Carolyn Chue Wai, Chee, Kok Yoon, Ng, Chong Guan, Lit, Lei Cheng, Anuar, Anis Nadhirah Khairul, Lange, Lara M., Fang, Zih-Hua, Ciga, Sara Bandres, Lohmann, Katja, Klein, Christine, Ahmad-Annuar, Azlina, Muthusamy, Kalai Arasu, Lim, Shen-Yang
• Format: Article
• Language: English
• ISSN: 1877-7171; 1877-718X
• DOI: 10.1177/1877718X241297715

Plain Language Summary Deep brain stimulation (DBS) is a highly effective treatment for several movement disorders, including Parkinson's disease (PD). However, there is very limited published information about DBS in developing countries, and on “real-life” outcomes when DBS is performed earlier in the course of PD. Here, we describe a relatively large cohort of patients who underwent DBS at a major hospital in Kuala Lumpur, Malaysia. DBS was effective with low complication rates, and at 6–12 months after surgery, the PD medication dosage was reduced by at least one-half in 4 out of 10 patients and by at least one-third in 7 out of 10 patients. Patients with PD who underwent DBS early in their disease course (within 5 years from diagnosis, comprising one-fifth of the patients), and those diagnosed at age 50 years or younger (comprising one-half of the patients), appeared to have larger reductions in their PD medications. A significant proportion of patients with PD (16%) who had genetic testing done were found to harbor monogenic (causative) gene variants or GBA1 risk gene variants, which have been associated with worse disease progression, and these patients had lesser medication reduction compared to GBA1 variant-negative patients. Less than two out of 10 patients (16%) had their DBS funded via the public health system. To our knowledge, this is the largest report on DBS from Southeast Asia and documents good outcomes overall, including in PD patients operated on early in their disease course, but highlights limited government funding for this potentially life-changing therapy as a significant barrier in developing countries.