• Ali Razmkon, Omid Yousefi, Raziyeh Rezaei, Sina Salehi, Peyman Petramfar, Arash Mani, Hashem Rahmati, Janardan Vaidyanathan, Ghazal Ilami, and Yalda Amirmoezzi.
• Research Center for Neuromodulation and Pain, Kowsar Hospital, Shiraz, Iran. Electronic address: ali.razmkon@gmail.com.
• World Neurosurg. 2019 Jan 1; 121: e129-e135.

ObjectiveTo report the establishment of a new center for deep brain stimulation (DBS) as a surgical treatment for Parkinson disease and the surgical outcomes, from 2014 to 2017 in Shiraz, Southern Iran.MethodsA new treatment program was established in Shiraz through a multidisciplinary team in 2014. Thirty-four patients underwent implantation of subthalamic nucleus (STN) electrodes during the last 3 years. Twenty-five patients fulfilled the minimum 6-month follow-up criteria. The baseline Unified Parkinson Disease Rating Scale (UPDRS) was assessed 1 month before surgery in both off-medication and on-medication states by a movement disorder neurologist. To evaluate the outcomes, subscores of the UPDRS were assessed in all patients before surgery and at least 6 months after the operation.ResultsAll 25 patients had advanced Parkinson disease categorized as stage 3 or 4 using the Hoehn and Yahr scale. STN DBS resulted in a dramatic improvement in motor function of most patients. A reduction in dopaminergic medication dosage (average 60% reduction) was observed. The mean improvement was 40% in UPDRS II and 67% in UPDRS III. No surgical or hardware complications were observed. Stimulation-related adverse effects, including increased falling and worsening of speech, occurred in a few patients after surgery. Most of the patients experienced weight gain after surgery.ConclusionsBilateral STN DBS is a satisfactory and safe treatment for carefully selected patients with advanced Parkinson disease. According to the results, the procedure can be performed safely and with comparable results in developing countries around the world.Copyright © 2018 Elsevier Inc. All rights reserved.

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