Parkinson's disease in the United Arab Emirates (UAE): Emirates Neurology Society consensus guidelines.

BACKGROUND

Parkinson's disease (PD) incidence has risen by more than eightfold in the United Arab Emirates (UAE) between 1990 and 2019, representing one of the highest increases globally and creating substantial pressure on a fragmented, multi-payer health system. Region-specific guidance has been lacking, leading clinicians to extrapolate from international guidelines that do not fully address formulary heterogeneity, advanced therapy centralization, and cultural factors.

METHODS

Under the auspices of the Emirates Neurology Society, a national taskforce of 10 specialists representing major PD centers across the UAE used a three-round modified Delphi process informed by systematic literature review and key randomized controlled trials. Recommendations were graded using a GRADE-aligned system (A-C, Good Practice Points) and adapted to UAE formulary, service configuration, and cultural context.

RESULTS

Consensus was achieved on 146 recommendations across eight domains: (1) mandatory adoption of MDS-2015 diagnostic criteria; (2) age-stratified pharmacologic algorithms with levodopa as first-line for older or cognitively vulnerable patients; (3) structured non-motor symptom management; (4) rehabilitation and UAE cultural lifestyle adaptations including Ramadan fasting management, DBS considerations in women, family-centered care, and multilingual practice; (5) advanced therapy referral using the 5-2-1 rule integrated with the Making Informed Decisions to Aid Timely Management of Parkinson's Disease (MANAGE-PD) tool, with five device-aided options (subcutaneous foslevodopa/foscarbidopa, apomorphine SC- subcutanous, LCIG- Levodopa Carbidopa Intestinal Gel, DBS- Deep Brain Stimulation, MRgFUS- MRI guided focussed ultrasound) presented through shared decision-making; (6) a three-tier service model; (7) UAE formulary mapping; and (8) center accreditation and registry metrics. Advanced therapies are centralized in accredited centers with clear minimum volume and multidisciplinary staffing criteria.

CONCLUSION

These UAE consensus recommendations provide a pragmatic, context-adapted framework for PD management, emphasizing structured diagnosis, age-appropriate pharmacotherapy, systematic use of MANAGE-PD and 5-2-1 for advanced therapy referral, culturally sensitive practice adaptations, and a three-tier network model integrated through the Malaffi health information exchange and a planned national PD registry.