Objective: Deep brain stimulation for pediatric movement disorder has been contemplated much less than adult counterpart. We discuss the outcome of DBS int them  children poise unique challenges. The ongoing brain development, both structural and physiological, can influence the outcome of DBS. However, DBS can be safe on selected cases in pediatric population, providing significant short as well as long-term symptomatic relief in addition to an improvement in the quality of life. .

Background: Deep brain stimulation surgery has revolutionized the management of several movement disorders. The procedure has been underutilized in pediatric population, and the available literatures are mostly limited to smaller case series. The aim of present study is to describe our experience and to analyze the efficacy and safety of DBS in pediatric population.

Method: We performed a retrospective search of our patient registry (Cleveland clinic, Ohio) of all patients undergoing DBS from 2003 to 2016. All patients who were ≤ 21 years of age at the time of cranial implantation of DBS were included in this series.

Results: Sixteen patients underwent deep brain stimulation in this period. Indications were genetic torsional dystonia (n=7), secondary dystonia (n=4), myoclonic dystonia (n=2), post-traumatic tremor (n=2), and Tourette’s syndrome (n=1). DYT 1 and DYT 11 were present in two cases each. Twelve patients in present series had bilateral surgery [b/l GPi at same sitting=8; b/l GPi one month apart=4; and b/l medial thalamic (Cm/ Pf) =1]. Four patients of generalized dystonia had >50% improvement in BFMDRS score after 4, 5.5, 6, and 6 years. Two patients needed revision, but improvement after first surgery could not be achieved. Four patients with secondary dystonia had stable improvement of BFMDRS score>50% after 3, 3, 5, and 12 years. Patients with myoclonic dystonia, and Tourette’s syndrome had stable improvement as well. The patients with post-traumatic tremor had experienced an initial improvement. However, they deteriorated over time, and stimulation had to be discontinued.

Conclusion: DBS in children poise unique challenges. The ongoing brain development, both structural and physiological, can influence the outcome of DBS. However, DBS can be safe on selected cases in pediatric population, providing significant short as well as long-term symptomatic relief in addition to an improvement in the quality of life.

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-in-children-analysis-of-indication-outcome-and-complications/