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Published on: August 12, 2018
Pediatric indications for deep brain stimulation
Matthew F DiFrancesco1, Casey H Halpern, Howard H Hurtig
1Center for Functional and Restorative Neurosurgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104-4399, USA.
Insights
Deep brain stimulation (DBS) shows promise for pediatric movement disorders, particularly dystonia. Further research is needed for other conditions like epilepsy and obesity in children.
Area of Science:
- Neurology
- Pediatric Medicine
- Neurosurgery
Background:
- Deep brain stimulation (DBS) has proven effective for adult neurological disorders.
- Its application in pediatric populations is an emerging field of study.
Purpose of the Study:
- To review current movement disorder indications for pediatric DBS.
- To explore potential psychiatric indications for pediatric DBS.
Main Methods:
- Structured literature review of English-language studies from 1990-2011.
- Searches conducted using Medline and PubMed databases for pediatric DBS research.
Main Results:
- Twenty-four pediatric DBS reports were identified.
- Dystonia is the most promising pediatric DBS application due to its disabling nature and low remission rate.
- Caution is advised for conditions with high adult remission rates (e.g., OCD, Tourette's) and those with significant pediatric morbidity (epilepsy, obesity).
Conclusions:
- Dystonia is currently the most promising pediatric DBS indication.
- Pediatric investigation of conditions being studied in adults (epilepsy, obesity, psychiatric disorders) is warranted.
Purpose:
Based on the success of deep brain stimulation (DBS) in the treatment of adult disorders, it is reasonable to assume that the application of DBS in the pediatric population is an emerging area worthy of study. The purpose of this paper is to outline the current movement disorder indications for DBS in the pediatric population, and to describe areas of investigation, including possible medically refractory psychiatric indications.
Methods:
We performed a structured review of the English language literature from 1990 to 2011 related to studies of DBS in pediatrics using Medline and PubMed search results.
Results:
Twenty-four reports of DBS in the pediatric population were found. Based on published data on the use of DBS for pediatric indications, there is a spectrum of clinical evidence for the use of DBS to treat different disorders. Dystonia, a disease associated with a low rate of remission and significant disability, is routinely treated with DBS and is currently the most promising pediatric application of DBS. We caution the application of DBS to conditions associated with a high remission rate later in adulthood, like obsessive-compulsive disorder and Tourette's syndrome. Moreover, epilepsy and obesity are currently being investigated as indications for DBS in the adult population; however, both are associated with significant morbidity in pediatrics.
Conclusion:
While currently dystonia is the most promising application of DBS in the pediatric population, multiple conditions currently being investigated in adults also afflict children and adolescents, and thus warrant further research.
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