Advanced Parkinson's disease and eligibility for device-aided therapies in Morocco: a multicenter cross-sectional study.

Abstract

Aim: This study investigates the prevalence and clinical features of advanced Parkinson's disease (APD) in Moroccan patients and evaluates their eligibility for Device-Aided Therapies (DATs), including Deep Brain Stimulation (DBS), Continuous Subcutaneous Apomorphine Infusion (CSAI), and Levodopa-Carbidopa Intestinal Gel infusion (LCIG).

Methods: We conducted a cross-sectional study across 15 facilities in five cities within the Casablanca-Settat region, Morocco. We collected demographics, clinical, and health-related quality of life data. Logistic regression identified factors predicting disease progression and DATs eligibility.

Results: This study included 370 patients with Parkinson's disease, of whom 44.6% (95%CI: 39.5%-49.8%) had APD. Each additional year of disease duration increased APD odds by 8% (ORa = 1.08, p = 0.047). Overall, 38.9% of patients qualified for at least one DAT, including 18.9% for DBS, 35.4% for CSAI, and 13.8% for LCIG; however, only one patient received DBS. Younger age at onset was associated with greater DATs eligibility, with each additional year reducing eligibility by 7% (ORa = 0.93, p < 0.001). Additionally, premotor REM sleep behavior disorder increased the odds of LCIG eligibility (ORa = 2.38, p = 0.009), while prior sports engagement nearly tripled the odds for CSAI (ORa = 2.87, p = 0.038).

Conclusion: Although many Moroccan patients qualify for DATs, their use is minimal. Addressing access barriers is crucial to improve outcomes.