Considerations in deep brain stimulation (DBS) for pediatric secondary dystonia

Title

Considerations in deep brain stimulation (DBS) for pediatric secondary dystonia

Creator

Tsering D; Tochen L; Lavenstein B; Reddy S K; Granader Y; Keating R F; Oluigbo C O

Publisher

Childs Nervous System

Date

2017

Subject

Pediatrics; Surgery; Neurosciences & Neurology; cerebral-palsy; Deep brain stimulation; globus-pallidus internus; hemidystonia; Secondary dystonia; Pediatric neurosurgery; surgical-treatment; tone and motor problems; IND; surgical intervention; deep brain stimulation; dystonia

Description

Purpose There is a paucity of effective long-term medication treatment for secondary dystonias. In situations where significantly impairing secondary dystonias fail to respond to typical enteral medications and intrathecal (or even intraventricular) baclofen, consideration should be given to the use of deep brain stimulation (DBS). While Level I evidence and long-term follow-up clearly demonstrate the efficacy of DBS for primary dystonia, the evidence for secondary dystonia remains mixed and unclear. In this study, we report our experience with pediatric subjects who have undergone DBS for secondary dystonia. Methods We discuss the indications and outcomes of DBS procedures completed at our center. We also present a detailed discussion of the considerations in the management of these patients as well as a literature review. Results Of the four cases retrospectively examined here, all subjects experienced reductions in the severity of their dystonia (ranging from 0 to 100% on both the Barry-Albright Dystonia (BAD) and Burke-Fahn-Marsden Dystonia Rating Scale-Motor (BFMDRS-M) scales). Conclusions Pallidal DBS should be considered among children with functionally debilitating, medication-resistant secondary dystonia. Patients without fixed skeletal deformities who have experienced a short duration of symptoms are most likely to benefit from this intervention.

Rights

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Citation

Tsering D; Tochen L; Lavenstein B; Reddy S K; Granader Y; Keating R F; Oluigbo C O, “Considerations in deep brain stimulation (DBS) for pediatric secondary dystonia,” Pediatric Palliative Care Library, accessed July 2, 2022, https://pedpalascnetlibrary.omeka.net/items/show/16832.

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