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A Gap Analysis of Deep Brain Stimulation for Childhood-Onset Movement Disorders
Daniela Munoz-Chesta1,2,3, Carolina Gorodetsky4, Todd M Herrington5
1Department of Pediatric Neurology and Psychiatry, San Borja Arriaran Hospital, University of Chile, Santiago, Chile.
Insights
Deep brain stimulation (DBS) for pediatric movement disorders faces challenges. Emerging strategies and international collaboration are key to improving care and access for children requiring this advanced neuromodulation therapy.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Movement Disorders
Background:
- Deep brain stimulation (DBS) is a recognized therapy for childhood-onset movement disorders.
- Current adult-derived DBS protocols present significant challenges for pediatric applications.
Purpose of the Study:
- Identify critical gaps in pediatric DBS.
- Highlight emerging strategies tailored for children across the care pathway.
Main Methods:
- Expert opinion from seven experienced pediatric DBS clinicians and researchers.
- Focused literature review on current gaps in pediatric DBS.
Main Results:
- Gaps persist in standardized pediatric selection, biomarkers, outcome definition, and global access.
- Emerging strategies include individualized, genotype-informed approaches, and technological advancements.
Conclusions:
- Pediatric DBS requires specialized frameworks and approaches.
- Individualized strategies, technological innovation, and global collaboration are crucial for advancing pediatric DBS.
Background:
Deep brain stimulation (DBS) is an established and increasingly utilized therapy for childhood-onset movement disorders. However, pediatric DBS poses unique challenges that are not adequately addressed by adult-derived paradigms.
Objective:
To identify key gaps in the current use of DBS in childhood-onset movement disorders and to highlight emerging pediatric-specific strategies across the care pathway, including patient selection, targeting, surgical approaches, programming, and outcome assessment.
Methods:
This educational review represents the opinions of seven clinicians and clinical researchers with extensive experience in pediatric DBS and was informed by a focused literature review of key domains identified by the authors as current gaps in the field.
Conclusions:
Despite substantial progress, important gaps persist across multiple domains of pediatric DBS, including the lack of standardized, pediatric-specific selection frameworks, limited biomarkers to guide therapy, challenges in defining meaningful outcomes, and significant global disparities in access. Emerging approaches, including individualized and genotype-informed strategies, advances in neuromodulation technology, and international collaboration, offer potential pathways to address these limitations. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
