Objective: This preliminary study aims to investigate the prevalence of advanced Parkinson’s disease (PD) among patients receiving treatment in the Casablanca region of Morocco.

Background: Managing advanced PD symptoms continue to present challenges [1], especially in developing regions like North Africa, where there is limited understanding of the prevalence of advanced PD patients who could potentially benefit from Device-Aided Therapies (DATs). This is further complicated by the region’s unique genetic landscape, characterized by the highest prevalence of the LRRK2 G2019S mutation in the world [2].

Method: This cross-sectional, multicenter study enrolled PD patients in the Casablanca-Settat region over 5 months. A representative sample was randomly selected from public and private neurological facilities across five cities. Advanced PD was classified based on the 5-2-1 criteria [3] and potential candidates for DATs were selected based on Antonini et al.’s criteria [4], which were determined through consensus using a multi-country Delphi-panel approach. These therapies encompass Deep Brain Stimulation (DBS), Continuous Subcutaneous Apomorphine Infusion (CSAI), and Levodopa/Carbidopa Intestinal Gel (LCIG). The study was approved by the local ethics committee on October 26, 2023 (Approval number: 06/2023).

Results: Among the 102 selected patients (mean age 66.8 ± 8.5 years; 59% male), the preliminary prevalence of advanced PD was found to be 32% (95%CI: 28.02-36.42%). The Hoehn and Yahr stage was I in 11.2% of the patients, II in 47%, III in 24.6%, IV in 14.1%, and V in 3.1%; 56% (95%CI: 46.3-65.7%) of the patients had comorbidities. Correlation analysis between clinicians’ judgment and the 5-2-1 criteria revealed a significant association. Specifically, 28 patients (27.4%; 95%CI: 19.3-36.7%) showed a good levodopa response, intact cognition, and were under 70 years old, qualifying them for all three DATs. Additionally, 15 patients (14.7%; 95%CI: 8.4-22.9%) with troublesome dyskinesia were considered suitable for both LCIG and DBS.

Conclusion: Further investigation with a larger sample size and longitudinal follow-up is warranted to validate these findings and guide clinical practice effectively. We aim to collect data from a total of 360 patients by the end of the study.

References: 1. Coelho M, Ferreira JJ. Late-stage Parkinson disease. Nat Rev Neurol. 8(8), 435–442 (2012).
2. El Otmani H, Daghi M, Tahiri Jouti N, Lesage S. An overview of the worldwide distribution of LRRK2 mutations in Parkinson’s disease. Neurodegener Dis Manag. 13(6), 335–350 (2023).
3. Malaty IA, Martinez-Martin P, Chaudhuri KR, et al. Does the 5–2-1 criteria identify patients with advanced Parkinson’s disease? Real-world screening accuracy and burden of 5–2-1-positive patients in 7 countries. BMC Neurology [Internet]. 22(1), 35 (2022).
4. Antonini A, Stoessl AJ, Kleinman LS, et al. Developing consensus among movement disorder specialists on clinical indicators for identification and management of advanced Parkinson’s disease: a multi-country Delphi-panel approach. Curr Med Res Opin. 34(12), 2063–2073 (2018).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/prevalence-of-advanced-parkinsons-disease-and-potential-candidacy-for-device-aided-therapies-in-the-casablanca-region-preliminary-results-of-a-multicenter-regional-study/