Deep Brain Stimulation in Moroccan Patients With Parkinson's Disease: The Experience of Neurology Department of Rabat

Abstract

Introduction: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known as a therapy of choice of advanced Parkinson's disease. The present study aimed to assess the beneficial and side effects of STN DBS in Moroccan Parkinsonian patients.Material and Methods: Thirty five patients underwent bilateral STN DBS from 2008 to 2016 in the Rabat University Hospital. Patients were assessed preoperatively and followed up for 6 to 12 months using the Unified Parkinson's Disease Rating Scale in four conditions (stimulation OFF and ON and medication OFF and ON), the levodopa-equivalent daily dose (LEDD), dyskinesia and fluctuation scores and PDQ39 scale for quality of life (QOL). Postoperative side effects were also recorded.Results: The mean age at disease onset was 42.31 ± 7.29 years [28–58] and the mean age at surgery was 54.66 ± 8.51 years [34–70]. The median disease duration was 11.95 ± 4.28 years [5–22]. Sixty-three percentage of patients were male. 11.4% of patients were tremor dominant while 45.71 showed akinetic-rigid form and 42.90 were classified as mixed phenotype. The LEDD before surgery was 1200 mg/day [800-1500]. All patients had motor fluctuations whereas non-motor fluctuations were present in 61.80% of cases. STN DBS decreased the LEDD by 51.72%, as the mean LEDD post-surgery was 450 [188-800]. The UPDRS-III was improved by 52.27%, dyskinesia score by 66.70% and motor fluctuations by 50%, whereas QOL improved by 27.12%. Post-operative side effects were hypophonia (2 cases), infection (3 cases), and pneumocephalus (2 cases).Conclusion: Our results showed that STN DBS is an effective treatment in Moroccan Parkinsonian patients leading to a major improvement of the most disabling symptoms (dyskinesia, motor fluctuation) and a better QOL.

Deep Brain Stimulation-Related Surgical Site Infections: A Systematic Review and Meta-Analysis

“…The main descriptive characteristics of the eligible studies are summarized in Table 1. All studies were of cohort design yielding a total sample size of 12,258 participants (10,42–106). The follow‐up period ranged from 0.5 to 22 years (median: 3.35 years).…”

Estimating the Risk of Deep Brain Stimulation in the Modern Era: 2008 to 2020

“…14,32 In total, 13 patients had either appearance of a mood disorder or recurrence of a previously diagnosed mood disorder. 10,25,30,37,39 In total, 136 patients developed postoperative confusion, delirium, or psychosis. 3,13,16,20,21,24,30,[37][38][39][40][41][42]…”

“…10,25,30,37,39 In total, 136 patients developed postoperative confusion, delirium, or psychosis. 3,13,16,20,21,24,30,[37][38][39][40][41][42]…”

“…The most common skin-related complication was infection and/or erosion, which was seen in 92 patients. [2][3][4][5][6]8,10,11,16,21,[25][26][27]29,32,37,[43][44][45][46][47][48][49][50] In total, 3 patients developed wound dehiscence. 20,28,30 In total, 2 patients went on to develop hematomas or seromas.…”

Parkinson’s disease – a review of pathogenesis, recent advances in management, and challenges of care in sub-Saharan Africa

“…Apart from a few centers in South Africa [130] and North Africa (Egypt [131] and Morocco [132]), expertise and facilities for DBS are in short supply across Africa. This, therefore, limits treatment options for many patients with advanced disease who no longer get benefits from dopaminergic medications and would otherwise benefit from this procedure.…”