Utilization of neurosurgical modalities for Parkinson’s disease in Southeast Asia

INTRODUCTION: Neurosurgical advancements in Parkinson's disease (PD) treatment can significantly improve symptoms. However, the use of these modalities in Southeast Asia (SEA) faces barriers. METHODS: We conducted an online cross-sectional survey among movement disorder specialists in SEA. Respondents provided country-level estimates of utilization, targets, financial coverage, and limitations in the utilization of four neurosurgical modalities. RESULTS: Six out of the seven countries reported neurosurgical treatment for PD. Deep brain stimulation (DBS) was reported to be available in 6 countries, averaging 16.2 ± 4.8 procedures yearly. Radiofrequency thermocoagulation (RFT) and magnetic resonance-guided focused ultrasound (MRgFUS) were reported in three and two countries, respectively, while no respondent reported the use of gamma knife radiosurgery for PD. Funding issues and patient-related factors were the most commonly reported barriers. Out-of-pocket payments remained the primary funding source for surgeries in 66% of countries, with the cost of DBS ranging from USD 32,000.00 to 50,500.00. CONCLUSIONS: This survey provides preliminary respondent-reported estimates of DBS, RFT, and MRgFUS utilization across participating SEA countries. DBS volumes were lower than the published estimates from neighbors in the Western Pacific Region. The lack of funding and patient factors are commonly reported factors that may limit the use of these neurosurgical treatments.