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Published on: January 6, 2011
Surgical Complications of Deep Brain Stimulation in Children Across Targets and Indications: Multicenter Analysis of
Arjun Balachandar1,2, Leonard H Verhey3, Karim Mithani4,5
1Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Deep brain stimulation (DBS) is safe for pediatric patients with movement disorders, drug-resistant epilepsy, or self-injurious behavior. While complications are low, movement disorders present a higher risk for major adverse events.
Area of Science:
- Pediatric Neurosurgery
- Neuromodulation
- Surgical Safety
Background:
- Deep brain stimulation (DBS) is an emerging therapy for pediatric conditions.
- Limited data exists on DBS complication rates in children across various indications.
- This study addresses the safety of DBS in pediatric patients with movement disorders, epilepsy, and neurodevelopmental disorders.
Purpose of the Study:
- To evaluate the safety and complication rates of DBS in pediatric patients.
- To compare complication rates across different indications: movement disorders (MD), drug-resistant epilepsy (DRE), and self-injurious behavior (SIB).
Main Methods:
- A multicenter North American cohort study (Child and Youth CompreHensIve Longitudinal Database for Deep Brain Stimulation).
- Prospective and retrospective data collection on demographic, clinical, operative, and postoperative variables.
- Analysis of major (permanent neurologic injury or requiring surgery) and minor complications.
Main Results:
- 130 children (3-18 years) underwent DBS; 59.2% for MD, 36.2% for DRE, 4.6% for SIB.
- Overall major complication rate was 11.5%, significantly higher in MD (15.6%) vs. DRE (4.3%).
- Lower weight and urgent intervention were associated with major complications; infection and hardware malfunction were common.
Conclusions:
- DBS demonstrates a favorable safety profile in pediatric patients across multiple indications.
- Movement disorders are associated with a higher risk of major complications compared to DRE.
- Findings support the safety of DBS in children, though further research on stimulation-related outcomes is warranted.
Background And Objectives:
Deep brain stimulation (DBS) is considered off-label and investigational in pediatric populations with some exceptions. There are limited data on the relative rates of complications after DBS across different indications and targets in children. This study aimed to evaluate the safety of DBS surgery for children with movement disorders (MDs; dystonia, chorea, or tic disorders), drug-resistant epilepsy (DRE), or neurodevelopmental disorders, namely, self-injurious behavior (SIB).
Methods:
Data were collected both prospectively and retrospectively from children implanted with DBS through the North American multicenter Child and Youth CompreHensIve Longitudinal Database for Deep Brain Stimulation and included demographic, clinical, operative, and postoperative variables. Complications included infection, noninfectious surgical site findings (dehiscence or seroma), hardware-related issues (disconnection or impedance change), intracranial injury, or other complications. The primary outcome was major complications, defined as any adverse event causing permanent neurologic injury or requiring surgical intervention. The secondary outcome was minor complications, defined as nonmajor complications. Generalized linear models were used to assess for any significant associations with complications.
Results:
A total of 130 children and youth (mean age 12.2 ± 4.2; range 3-18) years and weighing 12.5-126.6 kg underwent DBS. The most common indication was MD (77, 59.2%), followed by DRE (47, 36.2%) and SIB (6, 4.6%). Major complications occurred in 11.5%, with a greater likelihood in MD (n = 12, 15.6%) compared with DRE (n = 2, 4.3%; odds ratio [OR] 3.55, 95% CI 2.66-4.73, p < 0.001) and significantly associated with lower weight at surgery (p < 0.001) and urgent intervention (p = 0.028). These included infection (6.2%), hardware malfunction (3.1%), and wound dehiscence (0.8%). Minor complications were also higher with MD compared with DRE (OR 1.83, 95% CI 1.16-2.89, p = 0.010) occurring in 22 participants (16.9%; 14 MD, 7 DRE, 1 SIB), including infection (6.2%), high impedance (1.5%), unrelated hydrocephalus (0.8%), perioperative worsening of symptoms (3.8%), incidental tract hemorrhage (2.3%), and noninfectious peri-electrode cystic changes (0.8%).
Discussion:
DBS-associated complications were low across multiple pediatric indications and targets, with MD associated with higher risk of major complications. Limitations include a focus on surgical postoperative complications and not stimulation-related adverse outcomes. These findings demonstrate the safety profile of DBS in children in a large cohort.
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