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

IF 4 3区 医学 Q2 NEUROSCIENCES
Journal of Parkinson's disease Pub Date : 2025-02-01 Epub Date: 2024-12-08 DOI:10.1177/1877718X241297715
Alfand Marl F Dy Closas, Ai Huey Tan, Yi Wen Tay, Jia Wei Hor, Tzi Shin Toh, Jia Lun Lim, Choey Yee Lew, Chun Yoong Cham, Carolyn Chue Wai Yim, Kok Yoon Chee, Chong Guan Ng, Lei Cheng Lit, Anis Nadhirah Khairul Anuar, Lara M Lange, Zih-Hua Fang, Sara Bandres Ciga, Katja Lohmann, Christine Klein, Azlina Ahmad-Annuar, Kalai Arasu Muthusamy, Shen-Yang Lim
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引用次数: 0

Abstract

BackgroundThe availability of deep brain stimulation (DBS), a highly efficacious treatment for several movement disorders, remains low in developing countries, with scarce data available on utilization and outcomes.ObjectiveWe characterized the DBS cohort and outcomes at a Malaysian quaternary medical center.MethodsA retrospective chart review was done on DBS-related surgery at the University of Malaya, including clinico-demographic, genetics, and outcomes data focusing on post-operative medication reduction and complications.Results149 Parkinson's disease (PD) patients underwent DBS targeting the subthalamic nucleus. Six had globus pallidus internus DBS (primarily for dystonia). Only 16.1% of patients were government-funded. Of the 133 PD patients operated in the past decade (2013-2022), 25 (18.8%) had disease duration <5 years. At 6-12 months post-DBS, median levodopa-equivalent daily dose (LEDD) reduction was 440.5 [418.9] mg/day, corresponding to a reduction of ≥50% and ≥30% in 42.2% and 69.8% of patients, respectively. LEDD reductions were larger in the early-onset and short-duration subgroups. Three patients (1.9% of 155) had symptomatic intracranial hemorrhage, resulting in stroke in two. Pathogenic monogenic or GBA1 variants were detected in 12/76 (16%) of patients tested, mostly comprising the "severe" GBA1 variant p.L483P (12%).ConclusionsThis is the largest report on DBS from Southeast Asia. The procedures were effective, and complication rates on par with international norms. Our study found a high frequency of GBA1-PD; and included a substantial number of patients with short-duration PD, who had good outcomes. It also highlights regional inequities in access to device-aided therapy.

来自马来西亚现实世界深部脑刺激队列的新见解。
背景:脑深部电刺激(DBS)是治疗多种运动障碍的一种非常有效的方法,但在发展中国家的可用性仍然很低,关于使用和结果的数据很少。目的:我们描述了马来西亚一家第四医学中心的DBS队列和结果。方法:对马来亚大学dbs相关手术进行回顾性图表回顾,包括临床人口学、遗传学和术后用药减少和并发症的结局数据。结果:149例帕金森病(PD)患者接受了针对丘脑下核的DBS治疗。6人有内苍白球DBS(主要用于肌张力障碍)。只有16.1%的患者是由政府资助的。在过去十年(2013-2022)手术的133例PD患者中,在12/76(16%)的检测患者中检测到25例(18.8%)的疾病持续时间,其中大部分包括“严重”GBA1变体p.L483P(12%)。结论:这是东南亚最大规模的星展报告。手术有效,并发症发生率与国际标准相当。我们的研究发现GBA1-PD的频率很高;并纳入了大量短期PD患者,这些患者预后良好。报告还强调了在获得设备辅助治疗方面的区域不平等。脑深部电刺激(DBS)是一种非常有效的治疗多种运动障碍的方法,包括帕金森病(PD)。然而,关于发展中国家DBS的公开信息非常有限,以及在PD过程中早期进行DBS时的“现实”结果。在这里,我们描述了在马来西亚吉隆坡的一家大医院接受DBS的相对较大的患者队列。DBS有效且并发症发生率低,在手术后6-12个月,10例患者中有4例PD药物剂量减少了至少一半,10例患者中有7例减少了至少三分之一。在病程早期接受DBS治疗的PD患者(诊断后5年内,占患者的五分之一),以及年龄在50岁或以下的PD患者(占患者的一半),PD药物的减少幅度更大。有相当比例的PD患者(16%)进行了基因检测,发现携带单基因(致病)基因变异或GBA1风险基因变异,这些基因变异与更严重的疾病进展相关,与GBA1变异阴性患者相比,这些患者的药物减量较小。不到2 / 10的患者(16%)的DBS是由公共卫生系统资助的。据我们所知,这是东南亚最大的关于DBS的报告,总体上记录了良好的结果,包括在疾病早期进行手术的PD患者,但突出表明,在发展中国家,政府对这种可能改变生活的疗法的资助有限,这是一个重大障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.40
自引率
5.80%
发文量
338
审稿时长
>12 weeks
期刊介绍: The Journal of Parkinson''s Disease (JPD) publishes original research in basic science, translational research and clinical medicine in Parkinson’s disease in cooperation with the Journal of Alzheimer''s Disease. It features a first class Editorial Board and provides rigorous peer review and rapid online publication.
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