Remote deep brain stimulation programming in childhood dystonia: opportunities, challenges, and future directions

Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an established therapy for medically refractory childhood dystonia. Achieving optimal outcomes requires repeated programming by experienced multidisciplinary teams in specialized centers. Geographic distance, travel burden, and access to expertise pose major barriers to families long-term care.

This review summarizes literature and clinical experience on remote DBS programming for pediatric dystonia through March 2026 identified using targeted searches of PubMed and Embase. Telemedicine-enabled platforms allow clinicians to adjust stimulation parameters through secure interfaces while conducting real-time video assessments. Feasibility studies and early clinical applications indicate that remote programming is technically achievable, safe, and capable of delivering meaningful therapeutic adjustments without in-person visits. For children, who often require early programming, remote care can reduce travel, minimize disruption to school and family life, and facilitate therapy optimization. Challenges remain, including regulatory requirements, infrastructure needs, and development of standardized pediatric protocols.

Remote DBS programming is a promising strategy to expand access to specialized care for children with dystonia. As telemedicine technologies, digital motor assessments, and neuromodulation platforms advance, remote programming has potential to become an integral component of long-term pediatric DBS management, improving outcomes and easing families' burden.