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

Neurosurgical advancements in Parkinson’s disease (PD) treatment can significantly improve symptoms. However, the use of these modalities in Southeast Asia (SEA) faces barriers. 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. 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. 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. Parkinson’s disease (PD) is a progressive neurological condition that affects movement and can cause tremors, stiffness, and difficulty walking. While medications remain the main treatment, some patients may benefit from surgical procedures when their symptoms are no longer adequately controlled. However, access to these treatments varies across Southeast Asia. The study surveyed movement disorder specialists to understand which surgical treatments for PD were available in their countries, how frequently they were performed, and what factors limited their use. Among the responding countries, deep brain stimulation was the most widely reported treatment and was available in six countries. Other procedures, including radiofrequency thermocoagulation and magnetic resonance-guided focused ultrasound, were reported in three and two countries, respectively. The most frequently reported barriers were limited financial support and patient-related concerns. Patients often had to pay for these procedures themselves. These findings suggest that improving financial support, patient education, referral systems, and access to specialized services may help make surgical treatments more accessible.