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Published on: February 15, 2014
GNAO1 Mutation-Induced Pediatric Dystonic Storm Rescue With Pallidal Deep Brain Stimulation
C Michael Honey1, Armaan K Malhotra2, Maja Tarailo-Graovac3,4,5,6
11 Department of Surgery, Section of Neurosurgery, University of Manitoba, Winnipeg, Canada.
Insights
Dystonic storm, a severe movement disorder, can be effectively treated with deep brain stimulation. This therapy rapidly resolved symptoms in a pediatric patient with a GNAO1 mutation, offering a new treatment avenue.
Area of Science:
- Neurology
- Genetics
- Pediatric Intensive Care
Background:
- Dystonic storm (status dystonicus) is a critical hyperkinetic movement disorder causing excessive muscle contractions and biochemical changes.
- Management often involves pediatric intensive care unit (PICU) admission, medication, and sometimes general anesthesia with intubation for severe cases.
- Deep brain stimulation (DBS) of the globus pallidus has shown promise in resolving dystonic storms in pediatric patients.
Abstract:
Dystonic storm or status dystonicus is a life-threatening hyperkinetic movement disorder with biochemical alterations due to the excessive muscle contractions. The medical management can require pediatric intensive care unit admission and a combination of medications while the underlying trigger is managed. Severe cases may require general anesthesia and paralytic agents with intubation and may relapse when these drugs are weaned. Deep brain stimulation of the globus pallidum has been reported to terminate dystonic storm in several pediatric cases. We present a 10-year-old boy with a de novo GNAO1 mutation-induced dystonic storm who required a 2-month pediatric intensive care unit admission and remained refractory to all medical treatments. Deep brain stimulation was performed under general anesthetic without complication. His dyskinetic movements stopped with initiation of stimulation. He was discharged from the pediatric intensive care unit after 4 days. We present prospectively evaluated changes in dystonia symptoms and quality of life for a patient with GNAO1 mutation treated with deep brain stimulation.
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