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Published on: August 9, 2024
Deep brain stimulation reduces pain in children with dystonia, including in dyskinetic cerebral palsy
Sarah Perides1, Jean-Pierre Lin1, Geraldine Lee2
1Complex Motor Disorders Service, Evelina London Children's Hospital, London, UK.
Insights
Dystonic pain is common in children with dystonia, often improving significantly after deep brain stimulation (DBS). This surgical intervention offers substantial pain relief and improved quality of life for pediatric patients.
Area of Science:
- Neurology
- Pediatric Pain Management
- Neurosurgery
Background:
- Dystonic pain significantly impacts children's quality of life.
- Deep brain stimulation (DBS) is an established treatment for movement disorders.
Purpose of the Study:
- To determine the prevalence of dystonic pain in children.
- To evaluate the effectiveness of DBS in alleviating pain in pediatric dystonia patients.
Main Methods:
- A cohort of 140 children (median age 11y 11mo) undergoing DBS was studied over 10 years.
- Patients were categorized by dystonia aetiology (inherited, heredodegenerative, acquired, idiopathic).
- Pain and motor function were assessed using validated scales, including the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS).
Main Results:
- Dystonic pain was present in 45% of children, with 38% having cerebral palsy (CP).
- 90% of children experienced pain improvement 1 year after DBS across most aetiological groups.
- Significant improvements were observed in pain severity, frequency, and analgesic needs.
Conclusions:
- Dystonic pain is a frequent and treatable condition in pediatric patients undergoing DBS.
- DBS is an effective surgical goal for pain management in children with dystonia, regardless of aetiology.
- Multimodal approaches are recommended for pain research in this population.
Aim:
To establish the prevalence of dystonic pain in children and their response to deep brain stimulation (DBS).
Method:
Dystonic pain was assessed in a cohort of 140 children, 71 males and 69 females, median age 11 years 11 months (range 3y-19y 1mo), undergoing DBS in our centre over a period of 10 years. The cohort was divided into aetiological dystonia groups: 1a, inherited; 1b, heredodegenerative; 2, acquired; and 3, idiopathic. Motor responses were measured with the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS).
Results:
Dystonic pain was identified in 63 (45%) patients, 38% of whom had a diagnosis of cerebral palsy (CP). Dystonic pain improved in 90% of children and in all aetiological subgroups 1 year after DBS, while the BFMDRS motor score improved in 70%. Statistically significant improvement (p<0.01) was noted for the whole cohort on the Numerical Pain Rating Scale (n=27), Paediatric Pain Profile (n=17), and Caregivers Priorities and Child Health Index of Life with Disabilities questionnaire (n=48). There was reduction of pain severity, frequency, and analgesia requirement. Findings were similar for the whole cohort and aetiological subgroups other than the inherited heredodegenerative group where the improvement did not reach statistical significance.
Interpretation:
Dystonic pain is frequent in children with dystonia, including those with CP, who undergo DBS; this can be an important, realizable goal of surgery irrespective of aetiology. We encourage the use of multimodal approach in pain research to reduce the risk of bias.
