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Deep Brain Stimulation for Pediatric Dystonia: A Review of the Literature and Suggested Programming Algorithm
Rose Gelineau-Morel1, Michael C Kruer2, Jordan F Garris3
1Division of Neurology, Department of Pediatrics, Children's Mercy Hospital, 12273University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
Insights
This review proposes standardized guidelines for deep brain stimulation (DBS) in pediatric dystonia, addressing the lack of consensus for this effective treatment in children. It offers algorithms for programming and managing side effects to improve care.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Movement Disorders
Background:
- Deep brain stimulation (DBS) is a recognized treatment for pediatric movement disorders, particularly dystonia.
- Existing DBS guidelines are primarily for adults, leading to a lack of standardized pediatric care and underutilization.
- This gap necessitates evidence-based recommendations for pediatric DBS implementation.
Purpose of the Study:
- To develop standardized guidelines for candidate selection, surgical targets, and programming in pediatric dystonia.
- To provide practical algorithms for DBS programming and troubleshooting in pediatric patients.
- To serve as a resource for specialists using DBS for pediatric dystonia.
Main Methods:
- Convened a focus group of 13 pediatric movement disorder specialists and 1 neurosurgeon experienced in pediatric DBS.
- Reviewed current literature and clinical practices related to pediatric DBS for dystonia.
- Developed consensus-based algorithms for candidate selection, target site selection, and programming.
Main Results:
- Proposed standardized algorithms for initial and follow-up DBS programming sessions in pediatric dystonia.
- Provided detailed recommendations for troubleshooting common side effects during programming.
- Included discussion on the presentation and management of side effects.
Conclusions:
- Standardized guidelines are crucial for optimizing DBS therapy in pediatric dystonia.
- The proposed algorithms offer a framework for consistent and effective patient management.
- This resource aims to enhance the utilization and outcomes of DBS in children with dystonia.
Abstract:
Deep brain stimulation (DBS) is an established intervention for use in pediatric movement disorders, especially dystonia. Although multiple publications have provided guidelines for deep brain stimulation patient selection and programming in adults, there are no evidence-based or consensus statements published for pediatrics. The result is lack of standardized care and underutilization of this effective treatment. To this end, we assembled a focus group of 13 pediatric movement disorder specialists and 1 neurosurgeon experienced in pediatric deep brain stimulation to review recent literature and current practices and propose a standardized approach to candidate selection, implantation target site selection, and programming algorithms. For pediatric dystonia, we provide algorithms for (1) programming for initial session and follow-up sessions, and (2) troubleshooting side effects encountered during programming. We discuss common side effects, how they present, and recommendations for management. This topical review serves as a resource for movement disorders specialists interested in using deep brain stimulation for pediatric dystonia.
