Mohamed Daghi; Abdelhakim Lakhdar; Hicham El Otmani

doi:10.14802/jmd.24225

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Letter to the editor Barriers to Accessing Deep Brain Stimulation for Parkinson’s Disease Patients in Morocco: Mohamed Daghi¹, Abdelhakim Lakhdar^1,2, Hicham El Otmani^3,4; Journal of Movement Disorders 2025;18(1):106-107.
DOI: https://doi.org/10.14802/jmd.24225
Published online: December 9, 2024

¹Research Laboratory of Nervous System Diseases, Neurosensory Disorders and Disability, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco

²Neurosurgery Department, Ibn Rochd University Hospital Center, Casablanca, Morocco

³Neurology Department, Ibn Rochd University Hospital Center, Casablanca, Morocco

⁴Laboratory of Genetics and Molecular Pathology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco

Corresponding author: Mohamed Daghi, PhD Research Laboratory of Nervous System Diseases, Neurosensory Disorders and Disability, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, 19, Rue Tarik Ibnou Ziad B.P. 9154, Casablanca, Morocco / Tel: +212-666-40-80-17 / E-mail: meddaghi@gmail.com

• Received: November 3, 2024 • Revised: December 4, 2024 • Accepted: December 8, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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REFERENCES

Dear Editor,

We recently conducted a cross-sectional multicenter study to assess the prevalence of patients with Parkinson’s disease (PD) eligible for deep brain stimulation (DBS) in the Casablanca-Settat region of Morocco. The study, which included 370 patients from 15 public and private centers, was conducted over a 9-month period from October 2023 to June 2024 and received approval from the local Ethics Committee of the Faculty of Medicine and Pharmacy of Casablanca (Approval number: 06/2023). We found that approximately one-fifth (18.9%; 95% confidence interval 14.8–23.0) of these patients were definite candidates for DBS according to the Delphi consensus [1]. However, in our sample, only one eligible patient has received this intervention, highlighting a critical care gap. Although some centers in Morocco have started performing DBS with positive outcomes—with reported improvements ranging from 50% to 80 [2]%—these programs are undersupported.

This gap arises from multiple contributing factors. Socioeconomic challenges—such as high procedure costs and limited insurance coverage—delay DBS access for many patients, who often require years to prepare financially. Social support dynamics also impact decision-making. Patients often rely on family networks for guidance in major medical decisions. If family members or close friends lack understanding or hold negative views of DBS, patients may be less inclined to explore it as an option. In some cases, family members fear the financial and emotional burden associated with the procedure, which can also influence patients’ choices.

The shortage of movement disorder specialists is a significant barrier to care. Approximately two-thirds of countries in Africa have fewer than 30 neurologists, with some having none [3]. In Morocco, there are 330 neurologists (219 in the public sector and 111 in the private sector), equating to approximately 0.9 neurologists for every 100,000 individuals [4], compared with 7.1–9.2 neurologists per 100,000 population in high-income countries [5]. As well, services for neurological and neurosurgical conditions are concentrated in urban centers [4], leaving rural areas underserved. Although these specialists are dedicated to patient care, many lack the expertise to effectively manage DBS candidates. This shortage is compounded by the absence of local training programs for DBS, forcing interested practitioners to seek education abroad, further limiting the number of qualified providers in the country.

Interestingly, Morocco has one of the highest rates of the leucine-rich repeat kinase 2 G2019S mutation in the world, a genetic variant strongly associated with PD [6]. This mutation, which is common among North African populations, is a positive predictor of DBS outcomes [7]. However, financial support for genetic testing is largely unavailable, leaving many patients unaware of their genetic status. Without this information, patients and healthcare providers may miss opportunities for early intervention with DBS, reinforcing delays or dismissals due to incomplete knowledge.

Cultural perceptions also contribute to low uptake. Concerns about DBS risks, surgical permanence, and potential side effects discourage patients, even those eligible, from considering this option. Brain surgery often involves heightened fear and suspicion, particularly in cultures where invasive procedures in the brain evoke anxieties about personality changes, loss of control, or irreversible consequences. Moreover, neurological disorders are frequently misunderstood in many communities, with conditions such as PD sometimes viewed as natural signs of aging or even as moral weaknesses, creating a stigma around seeking surgical interventions. Families may regard PD as a condition to be managed conservatively, discouraging discussions about advanced therapies such as DBS and often advising against it. This cultural framing can prevent eligible patients from considering DBS, limiting their options for effective treatment.

Addressing these barriers requires targeted policy interventions and public awareness initiatives to improve DBS accessibility for PD patients in Morocco. Support for insurance reforms, local training programs to grow the DBS-specialist workforce, and efforts to counter cultural misconceptions through education can collectively empower patients and enhance their access to this advanced treatment.

Notes

Ethics Statement

The patient was fully informed about this research and gave consent to its publication. This study was approved by the local Ethics Committee for Biomedical Research of the Faculty of Medicine and Pharmacy of Casablanca (Approval number: 06/2023).

Conflicts of Interest

The authors have no financial conflicts of interest.

Funding Statement

None

Author Contributions

Conceptualization: all authors. Data curation: Mohamed Daghi, Hicham El Otmani. Methodology: Mohamed Daghi, Hicham El Otmani. Project administration: Mohamed Daghi, Hicham El Otmani. Supervision: Hicham El Otmani. Validation: Abdelhakim Lakhdar. Writing—original draft: Mohamed Daghi. Writing—review & editing: all authors.

Acknowledgments

None

REFERENCES

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