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@ARTICLE{DyClosas:277792,
      author       = {Dy Closas, Alfand Marl F and Tan, Ai Huey and Tay, Yi Wen
                      and Hor, Jia Wei and Toh, Tzi Shin and Lim, Jia Lun and Lew,
                      Choey Yee and Cham, Chun Yoong and Yim, Carolyn Chue Wai and
                      Chee, Kok Yoon and Ng, Chong Guan and Lit, Lei Cheng and
                      Anuar, Anis Nadhirah Khairul and Lange, Lara M and Fang,
                      Zih-Hua and Ciga, Sara Bandres and Lohmann, Katja and Klein,
                      Christine and Ahmad-Annuar, Azlina and Muthusamy, Kalai
                      Arasu and Lim, Shen-Yang},
      title        = {{N}ew insights from a {M}alaysian real-world deep brain
                      stimulation cohort.},
      journal      = {Journal of Parkinson's Disease},
      volume       = {15},
      number       = {1},
      issn         = {1877-7171},
      address      = {Amsterdam},
      publisher    = {IOS Press},
      reportid     = {DZNE-2025-00470},
      pages        = {1877718X241297715},
      year         = {2025},
      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.},
      keywords     = {Humans / Deep Brain Stimulation / Male / Female / Middle
                      Aged / Parkinson Disease: therapy / Retrospective Studies /
                      Aged / Malaysia / Subthalamic Nucleus / Adult / Globus
                      Pallidus / Glucosylceramidase / Levodopa: administration
                      $\&$ dosage / Cohort Studies / Asia (Other) / EARLYSTIM
                      (Other) / GBA1 (Other) / LRRK2 (Other) / Parkinson's disease
                      (Other) / access to care (Other) / deep brain stimulation
                      (Other) / dystonia (Other) / genetics (Other) / subthalamic
                      nucleus (Other) / Glucosylceramidase (NLM Chemicals) /
                      Levodopa (NLM Chemicals) / GBA protein, human (NLM
                      Chemicals)},
      cin          = {AG Heutink},
      ddc          = {610},
      cid          = {I:(DE-2719)1210002},
      pnm          = {354 - Disease Prevention and Healthy Aging (POF4-354)},
      pid          = {G:(DE-HGF)POF4-354},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:39973484},
      doi          = {10.1177/1877718X241297715},
      url          = {https://pub.dzne.de/record/277792},
}