D B S surgeries In Malaysia by Dr.NK.Chew 1

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Anonymous
Posted: Sun Sep 16, 2007 1:24 am Post subject: Discussion: Deep Brain Simulation Surgery in Malaysia

DBS was first carried out in Malaysia back in 2003, at Sunway Medical Centre, Kuala Lumpur (Dr Lee Moon Keen, Dr Chee Chee Pin, Dr Lee Foo Chiang). One year later, DBS was also started at University Malaya Medical Centre, Kuala Lumpur (Dr Vickneswaran, Dr Chew Nee Kong). So far, about a total of 20 Parkinson's patients in Malaysia have undergone DBS in these two local hospitals. Overall, the response to DBS has been encouraging. There has been significant improvement in symptoms (tremor and slowness of movement), reduction in dyskinesia and total daily dose of medications. Complication rate has been low. I saw with my own eyes how a few of my Parkinson's patients improved drastically after the DBS. Just imagine, prior to the arrival of DBS in Malaysia, I saw so many of my Parkinson's patients dying as a result of lung infection. The recent report on a successful DBS performed on another Parkinson's patient at University Sains Malaysia, Kubang Kerian, Kelantan, is really a giant leap forward in the history of Parkinson's care in Malaysia. Thus, the arrival of DBS in Malaysia is a good news to the Parkinson's community. The prevalence of PD in Malaysia is certainly not as high as that in North America and Europe, but we certainly have a sizeable Parkinson's population - estimated to be 15 000 Parkinson's patients. Of this, perhaps about 2000 patients (who are in the advanced stage of PD) would have benefited from DBS. But, it is sad that only about 20 Malaysian Parkinson's patients have been able to undergo this surgery locally. There are many reasons for this; a) lack of awareness on DBS as it is a new surgical procedure in Malaysia b) lack of funding - as DBS costs about RM80 000 for the first surgery and RM60 000 for each battery replacement, it is easily understood why most Parkinson's patients are reluctant to undergo DBS (most Parkinson's patients are retirees who have no permanent income). Furthermore, the Malaysian government has not set up any special funds for DBS. In contrast, in other countries such as United States and Europe, thousands of Parkinson's patients have successfully undergone DBS. When I was attached to the the Institute of Neurology, Queen Square, London, I saw the surgeons operating on about 2-3 Parkinson's patients per week. Therefore, there is much left to be done for the Parkinson's community in Malaysia - ignorance, misconceptions on PD, lack of neurologists / neurosurgeons and finally the financial difficulty (costs of medications and DBS are expensive). In Malaysia, there is a saying, "PD is a disease of rich people". I'd like to welcome comments from you and the colleagues from other countries (Kathrynn Holden, Dr Okun). Dr Chew Nee Kong, Neurologist, Kuala Lumpur, Malaysia.
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Mon Sep 17, 2007 6:11 am Post subject:

This is a very important post. Dr. Fernandez launched a program called SUPPORT-PD this year and Dr. Rodriguez, Foote, and myself were part of the team. We worked with a 3rd world country (Philippines) for one year setting up a referral network and interdisciplinary surgical team. We then came and lectured for a week in the country, increased awareness and enthusiasm, and then helped do two DBS surgeries with devices donated.... Anyone interested in this tyoe of program should contact Dr. Hubert Fernandez (University of Florida) who has been the visionary and planner for such programs. There is as you pointed out a great need for awareness and access to care. Also we can teach lesion procedures which are cheaper and also effective._________________Michael S. Okun, M.D.
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Anonymous
Posted: Thu Sep 27, 2007 9:48 pm Post subject:

Dear Dr Okun Congratulations for the excellent job in the Phillippines. Unlike in North America and European countries, Parkinson's brain surgery is still quite unknown by the public in Asian countries. I know that DBS is quite well established in Taiwan, Japan, Thailand and Singapore. However, in other Asian countries, DBS is either not available or at the preliminary stage. Even in Malaysia, DBS is still new. Thus, it is good news that the Parkinson's patients in the Phillippines have also benefited from DBS. Dr Chew Nee Kong, Kuala Lumpur, Malaysia
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Fri Sep 28, 2007 7:18 am Post subject:

Thanks we really enjoyed visiting and helping!_________________Michael S. Okun, M.D.
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