Objective: To describe the evolution of two cases of Parkinson’s disease treated with deep brain stimulation in CECANOT.

Background: Parkinson’s disease is the second most frequent neurodegenerative disease. Of every three patients diagnosed with Parkinson’s disease, one will be unemployed within 1 year, and most will be unemployed after 5 years. On average, patients with Parkinson’s disease will spend 1,000 to 6 billion dollars per year on medications. At present in our country we have the different therapies of the initial treatment, in advanced stages of the disease due to motor fluctuations, advanced therapies are usually necessary, this therapies are usually very expensive, of advanced therapies we only have deep brain stimulation (DBS), our center is the only one public center with access to patients with limited resources that offered DBS.

Method: Two patients with Parkinson’s disease were evaluated and diagnosed according to the Parkinson’s Disease criteria of the Brain Bank of the United Kingdom and of the Parkinson’s and Movements Disorders Society,  which met the criteria to be treated with advanced therapy: deep brain stimulation,  with placement of deep cerebral electrodes in bilateral subatamilac nuclei performing clinical monitoring and micro-registration. Clinical improvement was assessed through the unified scale of Parkinson’s disease and movements disorders society of abnormal movements part III (MDS UPDRS).

Results: In both patients, therapy with deep brain stimulation was initiated the second week after implantation of the electrodes, a good response to deep brain stimulation was observed from the first programming with an improvement with stimulation of 42% and 55% without drug effects dopaminergic at the time of the start of stimulation and subsequently both reduced their requirements of levodopa to doses less than 50% of those used before stimulation.

Conclusion: DBS improves the motor symptoms of Parkinson’s disease as well as independence for the daily living activities, but not all patients will be candidates for this therapy, nor will they have access. We intend to be able to offer all available therapies in Parkinson’s disease patients despite the limitations of our country.

References: 1. Bronstein JM, Tagliati M, Alterman RL, et al. Deep Brain Stimulation for Parkinson Disease. Arch Neurol. 2011;68(2):165. 2. Okun MS. Deep-brain stimulation for Parkinson’s disease. N Engl J Med 2012;367: 1529-38. 3. Christian J. Hartmann , Sabine Fliegen, Stefan J. Groiss, Lars Wojtecki and Alfons Schnitzler. An update on best practice of deep brain stimulation in Parkinson’s disease. Ther Adv Neurol Disord 2019, Vol. 12: 1–20. 4. Picillo, M., Lozano, A. M., Kou, N., Puppi Munhoz, R., & Fasano, A. (2016). Programming Deep Brain Stimulation for Parkinson’s Disease: The Toronto Western Hospital Algorithms. Brain Stimulation, 9(3), 425–437.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-as-the-only-advanced-therapy-available-in-the-dominican-rebublic-report-ot-two-cases-in-centro-cardio-neuro-oftalmologico-y-transplante-cecanot/