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Deep brain stimulation in children: experience and technical pearls
Ellen L Air1, Jill L Ostrem, Terence D Sanger
1Department of Neurosurgery, University of California, San Francisco, CA 94143-0221, USA.
Journal of Neurosurgery. Pediatrics
|December 3, 2011
Summary
Deep brain stimulation (DBS) offers promising results for pediatric dystonia, particularly DYT1, but shows limited efficacy for neurodegeneration with brain iron accumulation (NBIA). Younger children experienced a higher risk of hardware infections during DBS procedures.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Movement Disorders
Background:
- Deep brain stimulation (DBS) is a recognized treatment for adult movement disorders.
- Limited data exists on the technical aspects, complications, and outcomes of DBS in pediatric populations.
- Understanding DBS in children is crucial for expanding treatment options for pediatric neurological conditions.
Purpose of the Study:
- To evaluate the safety and efficacy of deep brain stimulation (DBS) in children with various movement disorders.
- To document surgical techniques, complications, and neurological outcomes in pediatric DBS patients.
- To compare DBS outcomes in children with specific diagnoses (e.g., DYT1 dystonia, NBIA) to adult data.
Main Methods:
- Retrospective review of a prospectively established database of DBS implantations since 1998.
- Inclusion criteria: patients younger than 18 years at the time of DBS surgery.
- Data collected: diagnoses, surgical techniques (microelectrode-guided vs. image-guided), complications, and neurological function assessed by standard rating scales.
Main Results:
- Thirty-one pediatric patients (ages 4-17) underwent DBS for diagnoses including DYT1 dystonia, secondary dystonia, and NBIA.
- Surgical techniques evolved; younger children (<10 years) had a higher incidence of hardware infections.
- One-year outcomes showed significant improvement in DYT1 dystonia (75% movement score improvement), modest results for secondary dystonia, and poor outcomes for NBIA.
Conclusions:
- DBS in children with primary and secondary dystonias yields results comparable to adults, with excellent outcomes for DYT1 dystonia.
- Pediatric DBS for NBIA showed disappointing results, contrasting with adult data.
- Younger age (<10 years) is associated with an increased risk of hardware infections in pediatric DBS patients.
