x Abu Dhabi, UAE Friday 21 July 2017

Surgical option for patients with movement disorders now in UAE

Deep-brain stimulation, in which parts of brain responsible for motor function are sparked, is performed in Abu Dhabi … but at a stiff price.

Dr Maher Mansour, consultant neurosurgeon at Sheikh Khalifa Medical City, is using cutting edge technologies to help patients deal with Parkinson's disease. The treatments do not offer a cure but can dramatically improve the lives of patients. (Lee Hoagland/The National)
Dr Maher Mansour, consultant neurosurgeon at Sheikh Khalifa Medical City, is using cutting edge technologies to help patients deal with Parkinson's disease. The treatments do not offer a cure but can dramatically improve the lives of patients. (Lee Hoagland/The National)

ABU DHABI //Patients with movement disorders have access to a surgical procedure that was previously only available abroad.

Sheikh Khalifa Medical City is the only hospital in the country to offer deep-brain stimulation, an operation that involves placing small electrodes in the brain to stimulate the areas responsible for motor function.

Deep-brain stimulation, or DBS, is approved by the US Food and Drug Administration for treating essential tremor, Parkinson's disease and dystonia.

It is recommended for patients who are no longer responding to medical treatment or can no longer tolerate the side effects of their drugs.

In Parkinson's patients, the procedure is performed while the patient is awake, to assess response.

The 1.2-millimetre electrodes are controlled by a stimulator placed just beneath the skin in the chest area, which can be adjusted wirelessly through a radio-frequency device.

Dr Maher Mansour, consultant neurosurgeon in brain and spine surgery at SKMC, said the procedure could take 12 hours because of its complexity.

"The difficulty of this procedure is in reaching a very small area in the deepest part of the brain," Dr Mansour said.

First, a series of MRI and CT scans localise the area. Five micro-electrodes are then inserted to record the electrical activity of the brain, as each area has its specific patterns.

Three of the closest electrodes are then used to test the effects of stimulation.

"In Parkinson's patients, you can immediately see the tremors stop," Dr Mansour said. "At the same time we can test for undesirable side effects."

If the electrode is too close to the motor track going from the brain to the peripheral muscles, the patient's muscles will contract. If it is too close to the nearby optical pathway, the patient will see flashes of light.

"The distance between the desirable effect and the undesirable effect is just one millimetre, which is the thickness of the electrode," Dr Mansour said. "It's all about precision. There's no room for error."

Finally, the micro-electrodes are replaced with the permanent electrodes and the same process is repeated for the other side.

At SKMC, the procedure costs about Dh230,000 and is typically not covered by insurance. Thiqa provides partial coverage for UAE nationals.

"It's new here and insurance companies are not familiar with it, although they would benefit in the long term," Dr Mansour said.

"A study in France showed that insurance companies got their money back from a Parkinson's disease patient who underwent DBS within 23 months of treatment because patients are hospitalised less, visit the doctor less and are on less medication."

Yet many patients still choose to travel abroad.

"There is a lack of awareness and there's also lack of trust, for sure, especially among the Emiratis," Dr Mansour said.

"We tell them we're educated abroad, we have our training and experience abroad, but they still insist - and the cost of sending a patient abroad is about 10 times the amount of treating them here."

The challenge in offering DBS at hospitals other than SKMC lies in finding qualified surgeons and the expenses involved, doctors said.

Rashid Hospital in Dubai treats about 100 Parkinson's patients, adding one or two each month.

Every year, the hospital sends about 10 patients abroad to receive DBS.

"Ten out of 100 is a good number and is worth the investment," said Dr Abubaker Al Madani, head of neurology at Rashid, who has developed a plan with his colleagues to launch a DBS centre in Dubai.

Although there are no figures on the prevalence of Parkinson's in the UAE, experts estimate it is similar to the worldwide rate of 1 per cent of people over age 60.

Part of the problem is the lack of data, said Omar El Agnaf, professor of biochemistry at UAE University.

"The first step to tackle any disease is to know the incidence, so epidemiological studies are very important to give us an idea where we are, what we are facing and then how to handle it," Prof El Agnaf said.

A series of studies partially funded by the Michael J Fox Foundation found the mutation of one particular gene accounted for between 30 and 40 per cent of Parkinson's cases in Morocco, Tunisia, Algeria and Libya.

Overall, genetics account for only 10 per cent of cases worldwide.

"This gives you a clear message that we have a unique population and maybe in the future, whatever treatment developed will be based on these findings," Dr El Agnaf said.

"We need clinical centres focusing on neurodegenerative diseases, to treat patients and do research.

"We need this for our own population because we are different and nobody will do it for us unless we do it for ourselves."

mismail@thenational.ae