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Pediatric Deep Brain Stimulation Using Awake Recording and Stimulation for Target Selection in an Inpatient
Terence D Sanger1,2, Mark Liker3, Enrique Arguelles4
1Department of Neurology, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. terry@sangerlab.net.
Insights
A new Neuromodulation Monitoring Unit (NMU) targeting technique improved deep brain stimulation (DBS) outcomes for children with secondary dystonia. This method enhances electrode placement accuracy, leading to greater symptom improvement compared to standard procedures.
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.
Abstract:
Deep brain stimulation (DBS) for secondary (acquired, combined) dystonia does not reach the high degree of efficacy achieved in primary (genetic, isolated) dystonia. We hypothesize that this may be due to variability in the underlying injury, so that different children may require placement of electrodes in different regions of basal ganglia and thalamus. We describe a new targeting procedure in which temporary depth electrodes are placed at multiple possible targets in basal ganglia and thalamus, and probing for efficacy is performed using test stimulation and recording while children remain for one week in an inpatient Neuromodulation Monitoring Unit (NMU). Nine Children with severe secondary dystonia underwent the NMU targeting procedure. In all cases, 4 electrodes were implanted. We compared the results to 6 children who had previously had 4 electrodes implanted using standard intraoperative microelectrode targeting techniques. Results showed a significant benefit, with 80% of children with NMU targeting achieving greater than 5-point improvement on the Burke⁻Fahn⁻Marsden Dystonia Rating Scale (BFMDRS), compared with 50% of children using intraoperative targeting. NMU targeting improved BFMDRS by an average of 17.1 whereas intraoperative targeting improved by an average of 10.3. These preliminary results support the use of test stimulation and recording in a Neuromodulation Monitoring Unit (NMU) as a new technique with the potential to improve outcomes following DBS in children with secondary (acquired) dystonia. A larger sample size will be needed to confirm these results.
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