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Hicham El Otmani *1 
, Mohamed Daghi2 , Maha Abdallaoui1 , Bouchra El Moutawakil1 , Mohammed Abdoh Rafai1 , Nadia Tahiri Jouti3 , Suzanne Lesage4 , Abdelhakim Lakhdar5
, Mohamed Daghi2 , Maha Abdallaoui1 , Bouchra El Moutawakil1 , Mohammed Abdoh Rafai1 , Nadia Tahiri Jouti3 , Suzanne Lesage4 , Abdelhakim Lakhdar5
1- Neurology Department, Ibn Rochd University Hospital Center, Casablanca, Morocco
2- Research Laboratory of Nervous System Diseases, Neurosensory Disorders, and Disability, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
3- Laboratory of Cellular and Molecular Inflammatory, Degenerative and Oncologic Pathophysiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
4- Sorbonne University, Institut du Cerveau-Paris Brain Institute, ICM, INSERM, CNRS, Assistance Publique-Hôpitaux de Paris, Paris, France
5- Neurosurgery Department, Ibn Rochd University Hospital Center, Casablanca, Morocco
2- Research Laboratory of Nervous System Diseases, Neurosensory Disorders, and Disability, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
3- Laboratory of Cellular and Molecular Inflammatory, Degenerative and Oncologic Pathophysiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
4- Sorbonne University, Institut du Cerveau-Paris Brain Institute, ICM, INSERM, CNRS, Assistance Publique-Hôpitaux de Paris, Paris, France
5- Neurosurgery Department, Ibn Rochd University Hospital Center, Casablanca, Morocco
Abstract:
Introduction: Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) is an established treatment for early-onset Parkinson’s disease (EOPD). While the effect of STN-DBS on patients with LRRK2-G2019S mutation has been largely investigated, data specific to EOPD patients with this mutation remain scarce. This study assesses how the G2019S mutation impacts STN-DBS outcomes in EOPD patients in Morocco, a developing country where such treatment is challenging to provide.
Methods: A prospective cohort study was conducted at the University Hospital of Ibn Rochd in Casablanca. Genomic DNA was analyzed for LRRK2-G2019S mutation, and clinical data were collected pre- and post-surgery. Motor outcomes, including dyskinesia, motor fluctuations, and levodopa equivalent daily dose (LEDD) reduction, were assessed one-year post-DBS.
Results: Seventeen EOPD patients who underwent STN-DBS were included, with 10 (58.8%) being LRRK2-G2019S mutation carriers. The mean age of participants was 57.2 ± 8.4 years, with an average age at onset of 37.9 ± 6.2 years. Motor fluctuations were present in 88.2% of patients, and 94.1% experienced dyskinesia. Post-DBS, both mutation carriers and non-carriers showed significant improvements in motor symptoms, with a mean UPDRS III improvement of 61.3%. Dyskinesia and motor fluctuations, as measured by specific UPDRS IV items, improved by 77.1% and 83.8%, respectively, with a mean LEDD reduction of 60.6%. Improvements were comparable between G2019S carriers and non-carriers. All patients were satisfied with the treatment, though one patient had a hardware-related infection.
Conclusion: STN-DBS is effective in managing motor symptoms and reducing medication needs in EOPD patients, regardless of LRRK2-G2019S mutation status.
Methods: A prospective cohort study was conducted at the University Hospital of Ibn Rochd in Casablanca. Genomic DNA was analyzed for LRRK2-G2019S mutation, and clinical data were collected pre- and post-surgery. Motor outcomes, including dyskinesia, motor fluctuations, and levodopa equivalent daily dose (LEDD) reduction, were assessed one-year post-DBS.
Results: Seventeen EOPD patients who underwent STN-DBS were included, with 10 (58.8%) being LRRK2-G2019S mutation carriers. The mean age of participants was 57.2 ± 8.4 years, with an average age at onset of 37.9 ± 6.2 years. Motor fluctuations were present in 88.2% of patients, and 94.1% experienced dyskinesia. Post-DBS, both mutation carriers and non-carriers showed significant improvements in motor symptoms, with a mean UPDRS III improvement of 61.3%. Dyskinesia and motor fluctuations, as measured by specific UPDRS IV items, improved by 77.1% and 83.8%, respectively, with a mean LEDD reduction of 60.6%. Improvements were comparable between G2019S carriers and non-carriers. All patients were satisfied with the treatment, though one patient had a hardware-related infection.
Conclusion: STN-DBS is effective in managing motor symptoms and reducing medication needs in EOPD patients, regardless of LRRK2-G2019S mutation status.
Keywords: Early-onset Parkinson's disease, Deep brain stimulation, Subthalamic nucleus, LRRK2 mutations
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