Pediatric Deep Brain Stimulation Using Awake Recording and Stimulation for Target Selection in an Inpatient...

Area of Science:

• Neurology
• Neurosurgery
• Biomedical Engineering

Background:

• Deep brain stimulation (DBS) efficacy for secondary dystonia is lower than for primary dystonia.
• Variability in acquired injuries may necessitate individualized electrode placement in the basal ganglia and thalamus.

Purpose of the Study:

• To introduce and evaluate a novel targeting procedure using a Neuromodulation Monitoring Unit (NMU) for children with severe secondary dystonia.
• To compare the efficacy of NMU targeting with standard intraoperative microelectrode targeting.

Main Methods:

• Temporary depth electrodes were placed at multiple potential targets in the basal ganglia and thalamus.
• Test stimulation and recording were performed in an inpatient NMU over one week.
• Four electrodes were implanted in nine children undergoing NMU targeting and six children using standard techniques.

Main Results:

• 80% of children with NMU targeting achieved >5-point improvement on the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), versus 50% with standard targeting.
• NMU targeting resulted in an average BFMDRS improvement of 17.1 points, compared to 10.3 points with standard targeting.

Conclusions:

• The NMU targeting technique shows potential for improving DBS outcomes in pediatric secondary dystonia.
• Further research with larger sample sizes is required to validate these preliminary findings.