Deep brain stimulation in the Middle East: First UAE experience comparing subthalamic and pallidal targets for Parkinson's disease

INTRODUCTION: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus internus (GPi) is an established therapy for advanced Parkinson's disease (PD). However, comparative outcome data from the Middle East are limited, and it remains unclear whether target-specific differences reported in randomized trials translate to regional real-world practice. We report outcomes of STN and GPi DBS from a single tertiary center in the United Arab Emirates. METHODS: We retrospectively reviewed 50 consecutive patients with PD who underwent bilateral STN or GPi DBS between 2020 and 2025 (37 STN, 13 GPi). Demographics, clinical phenotype, levodopa equivalent daily dose (LEDD), Unified Parkinson's Disease Rating Scale part III (UPDRS-III) scores, and adverse events were collected. Outcomes were summarized by target, with exploratory comparisons acknowledging baseline heterogeneity and limited statistical power. RESULTS: GPi patients had earlier motor symptom onset and universal dyskinesias, while STN candidates demonstrated more heterogeneous phenotypes. Both targets were associated with substantial LEDD reduction (STN 49.9% ± 32.4; GPi 37.5% ± 22.0). Variability and unequal sample sizes limited definitive target comparisons. Mean OFF-medication to DBS-ON UPDRS-III improvement exceeded 80% for both targets, likely influenced by high levodopa responsiveness, non-blinded assessments, and variable postoperative timing. CONCLUSIONS: In this first institutional comparative DBS analysis from the UAE, both STN and GPi DBS produced meaningful medication reduction and robust motor improvement, demonstrating that outcomes comparable to landmark trials are achievable within an emerging Middle Eastern neuromodulation program. Methodological limitations preclude conclusions on target superiority and underscore the need for larger prospective regional studies.