Deep Brain Stimulation Outreach Program to PD Patients from Laos
Chulalongkorn Center of Excellence on Parkinson's Disease & Related Disorders, Chulalongkorn University Hospital and Thai Red Cross Society, Bangkok 10330, Thailand.
Deep brain stimulation (DBS) is accepted as one of the therapeutic options for advanced Parkinson's disease (PD) because of its documented efficacy. Even though DBS has been performed in Europe and United States for several years, it is regarded as innovative in Thailand. Since it was introduced in Thailand during the last decade, this procedure has been limited exclusively to a few university hospitals given a lack of budget allocation and few neurologists and neurosurgeons trained in this procedure.
However, given the accumulated data confirming the positive outcomes of DBS and with many efforts by treating physicians in Thailand, DBS treatment has been included in the government insurance on special circumstances, covering main expenses for the patients who are government officers. With this development it is anticipated that there will be a marked increase in the number of DBS performed over the next few years in Thailand. Interestingly, this increase is anticipated to include not only Thai patients but also those from our neighboring countries e.g. Laos, Cambodia and Myanmar (Figure).
For the patients from neighboring countries, expenses for the DBS procedure, as well as the related medication costs seem to be a critical issue. For example, one patient from Laos who was suffering from motor complications, particularly disabling dyskinesis, and his symptoms were not controlled with all available medications in Laos. The DBS team at Chulalongkorn Center of Excellence on Parkinson's Disease and neurologists at Khon Kaen University closely worked together in order to evaluate the Laotian patient and finally performed bilateral subthalamic nucleus (STN) DBS successfully. The patient experiences excellent benefits with marked improvement of "on" time and reduction of dyskinesia. The Health Frontiers, the international organization (www.healthfrontiers.org), supported this effort and were responsible for most of the patient's expenses. We are all grateful to them for making DBS surgery possible for this Laotian patient.
For the future, developing an international network to facilitate collaboration among individuals as well as organizations will improve and expand the standard of care, including treatment with DBS surgery in many more Asian countries.
Natlada Limotai, MD.
Roongroj Bhidayasiri, MD, FRCP