Deep Brain Stimulation Surgery: Publications

  1. Lee, M.K., Lee, F.C., Chee, C.P.  DBS in Malaysia – 10 years experience – Abstract   Proceedings of the Malaysia Parkinson’s Disease and DBS Conference, 23-24 August 2013, Penang, Malaysia.
  2. Lee, F.C, Lee, M.K., Chee C.P.  Malaysian Experience in Deep Brain Stimulation for Parkinson’s Disease – Long Term Results.  Proceedings of the 8th Asian Congress of Neurological Surgeons, 20-24 November 2010, Kuala Lumpur, Malaysia.
  3. Lee, M.K., Lee, F.C., Chee, C.P.  Deep Brain Stimulation for Parkinson’s Disease: preservation of efficacy after seven years.  Poster: Neuroscience 2010: Annual Scientific Meeting of the Malaysian Society of Neurosciences, Kota Kinabalu, 21-23 May 2010.
  4. Lee, F.C, Lee, M.K., Chee C.P.  The SunMed Deep Brain Stimulation Programme for Parkinson’s Disease: Review after five years.  Proceedings of the 7th Asian Congress of Neurological Surgeons, Beijing, 19-22 June 2008.
  5. Lee, M.K., Lee, F.C., Chee, C.P.  The SunMed Deep Brain Stimulation Programme for Parkinson’s Disease: Review after four years.  Parkinsonism and Related Disorders 2007; 13:S165-S165.
  6. Lee MK, Lee FC, Chee CP.  Deep brain stimulation for Parkinson’s disease: early experience in Malaysia. Poster: European Society for Stereotactic and Functional Neurosurgery, Vienna, Austria, 23-26 June 2004.

ABSTRACT:  Deep Brain Stimulation for Parkinson’s Disease: preservation of efficacy after seven years

Lee, M.K., Lee, F.C., Chee, C.P.  Sunway Medical Centre, Selangor, Malaysia

Objective:  A comprehensive functional neurosurgery programme was developed at Sunway Medical Centre for deep brain stimulation (DBS) in patients with movement disorders.  This report documents the outcomes for Parkinson’s disease seven years after its inception.

Methods:  A clinical protocol was designed for selection and preoperative assessment of patients.  Criteria for surgery were functional impairment which could not be managed with best medical therapy, and levodopa-induced dyskinesia.  We employed MRI-based stereotactic target localisation, augmented with navigation software.  All patients had electrophysiological mapping.  Final confirmation of target localisation was performed with MacroStimulation.

Results:  Between February 2003 and April 2010, 40 leads were implanted in 19 patients (age 42-71 years; duration of PD 4-25 years).  Four patients had previous surgery elsewhere.  All patients had subthalamic nucleus as the implantation target.  15 of 19 patients (79%) showed good improvement in motor function (70% reduction in mean UPDRS Motor Score).  Good responders included two who had prior unilateral pallidotomy.  All except one had significant reduction in dyskinesia scores.  Dosage of medication was reduced by about half.  At follow-up (11-86 months), functional outcomes were maintained after allowing for age-related decline and disease progression.  The oldest patient (now aged 78) continues to show benefit after seven years.

There were two perioperative complications: one parenchymal haemorrhage and one self-limited subdural effusion.  Four patients had unsatisfactory outcome due to prior surgery (2), perioperative haemorrhage and probable parkinsonism-plus syndrome with initial good levodopa response.  Two patients had lead infection which eventually required ex-plantation.  Two patients died of unrelated causes.

Conclusion: Our DBS programme for PD has shown sustained benefit in patients for up to seven years.

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