Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gil-Robles S, Cif L, Biolsi B, Tancu C, El Fertit H, Coubes P (2006) Neurosurgical treatment in childhood dystonias and dyskinesias. Rev Neurol 43(Suppl 1):S169–S172

    PubMed  Google Scholar 

  2. Jani JM, Oluigbo CO, Reddy SK (2015) Anesthesia for deep brain stimulation in traumatic brain injury-induced hemidystonia. Clinical case reports 3:492–495

    Article  PubMed  PubMed Central  Google Scholar 

  3. Oluigbo CO, Salma A, Rezai AR (2012) Deep brain stimulation for neurological disorders. IEEE Rev Biomed Eng 5:88–99

    Article  PubMed  Google Scholar 

  4. Cif L, Coubes P (2017) Historical developments in children’s deep brain stimulation. Eur J Paediatr Neurol 21:109–17

  5. Kupsch A, Benecke R, Muller J, Trottenberg T, Schneider GH, Poewe W, Eisner W, Wolters A, Muller JU, Deuschl G, Pinsker MO, Skogseid IM, Roeste GK, Vollmer-Haase J, Brentrup A, Krause M, Tronnier V, Schnitzler A, Voges J, Nikkhah G, Vesper J, Naumann M, Volkmann J (2006) Pallidal deep-brain stimulation in primary generalized or segmental dystonia. N Engl J Med 355:1978–1990

    Article  CAS  PubMed  Google Scholar 

  6. Vidailhet M, Vercueil L, Houeto JL, Krystkowiak P, Benabid AL, Cornu P, Lagrange C, Tezenas du Montcel S, Dormont D, Grand S, Blond S, Detante O, Pillon B, Ardouin C, Agid Y, Destee A, Pollak P (2005) Bilateral deep-brain stimulation of the globus pallidus in primary generalized dystonia. N Engl J Med 352:459–467

    Article  CAS  PubMed  Google Scholar 

  7. Gonzalez V, Le Bars E, Cif L, van Dokkum LE, Laffont I, Bonafe A, Menjot de Champfleur N, Zanca M, Coubes P (2015) The reorganization of motor network in hemidystonia from the perspective of deep brain stimulation. Brain imaging and behavior 9:223–235

    Article  PubMed  Google Scholar 

  8. Gimeno H, Tustin K, Selway R, Lin JP (2012) Beyond the Burke-Fahn-Marsden dystonia rating scale: deep brain stimulation in childhood secondary dystonia. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society 16:501–508

    Article  Google Scholar 

  9. Marks W, Bailey L, Reed M, Pomykal A, Mercer M, Macomber D, Acosta F Jr, Honeycutt J (2013) Pallidal stimulation in children: comparison between cerebral palsy and DYT1 dystonia. J Child Neurol 28:840–848

    Article  PubMed  Google Scholar 

  10. Marks WA, Honeycutt J, Acosta F, Reed M (2009) Deep brain stimulation for pediatric movement disorders. Semin Pediatr Neurol 16:90–98

    Article  PubMed  Google Scholar 

  11. Keen JR, Przekop A, Olaya JE, Zouros A, Hsu FP (2014) Deep brain stimulation for the treatment of childhood dystonic cerebral palsy. J Neurosurg Pediatr 14:585–593

    Article  PubMed  Google Scholar 

  12. Maldonado IL, Roujeau T, Cif L, Gonzalez V, El-Fertit H, Vasques X, Bonafe A, Coubes P (2009) Magnetic resonance-based deep brain stimulation technique: a series of 478 consecutive implanted electrodes with no perioperative intracerebral hemorrhage. Neurosurgery 65:196–201 discussion -2

    PubMed  Google Scholar 

  13. Isaias IU, Alterman RL, Tagliati M (2008) Outcome predictors of pallidal stimulation in patients with primary dystonia: the role of disease duration. Brain : a journal of neurology 131:1895–1902

    Article  Google Scholar 

  14. Mehrkens JH, Borggraefe I, Feddersen B, Heinen F, Botzel K (2010) Early globus pallidus internus stimulation in pediatric patients with generalized primary dystonia: long-term efficacy and safety. J Child Neurol 25:1355–1361

    Article  PubMed  Google Scholar 

  15. Yilmaz S, Turhan T, Ceylaner S, Gokben S, Tekgul H, Serdaroglu G (2016) Excellent response to deep brain stimulation in a young girl with GNAO1-related progressive choreoathetosis. Child’s nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 32:1567–1568

    Article  Google Scholar 

  16. Speelman JD, Contarino MF, Schuurman PR, Tijssen MA, de Bie RM (2010) Deep brain stimulation for dystonia: patient selection and outcomes. Eur J Neurol 17(Suppl 1):102–106

    Article  PubMed  Google Scholar 

  17. Sayer C, Lumsden DE, Perides S, Tustin K, Bassi S, Lin JP, Kaminska M (2015) Intrathecal baclofen trials: complications and positive yield in a pediatric cohort. Journal of neurosurgery Pediatrics: 1–6

  18. Moro E, Gross RE, Krauss JK (2013) What’s new in surgical treatment for dystonia? Movement disorders : official journal of the Movement Disorder Society 28:1013–1020

    Article  Google Scholar 

  19. Saleh C, Gonzalez V, Coubes P (2013) Role of deep brain stimulation in the treatment of secondary dystonia-dyskinesia syndromes. Handb Clin Neurol 116:189–208

    Article  PubMed  Google Scholar 

  20. Lim BC, Ki CS, Cho A, Hwang H, Kim KJ, Hwang YS, Kim YE, Yun JY, Jeon BS, Lim YH, Paek SH, Chae JH (2012) Pantothenate kinase-associated neurodegeneration in Korea: recurrent R440P mutation in PANK2 and outcome of deep brain stimulation. Eur J Neurol 19:556–561

    Article  CAS  PubMed  Google Scholar 

  21. Sathe KP, Hegde AU, Doshi PK (2013) Deep brain stimulation improves quality of life in pantothenate kinase-associated neurodegeneration. J Pediatr Neurosci 8:46–48

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lipsman N, Ellis M, Lozano AM (2010) Current and future indications for deep brain stimulation in pediatric populations. Neurosurg Focus 29:E2

    Article  PubMed  Google Scholar 

  23. Marks WA, Honeycutt J, Acosta F Jr, Reed M, Bailey L, Pomykal A, Mercer M (2011) Dystonia due to cerebral palsy responds to deep brain stimulation of the globus pallidus internus. Movement disorders : official journal of the Movement Disorder Society 26:1748–1751

    Article  Google Scholar 

  24. Tierney TS, Lozano AM (2012) Surgical treatment for secondary dystonia. Movement disorders : official journal of the Movement Disorder Society 27:1598–1605

    Article  Google Scholar 

  25. Damier P, Thobois S, Witjas T, Cuny E, Derost P, Raoul S, Mertens P, Peragut JC, Lemaire JJ, Burbaud P, Nguyen JM, Llorca PM, Rascol O (2007) Bilateral deep brain stimulation of the globus pallidus to treat tardive dyskinesia. Arch Gen Psychiatry 64:170–176

    Article  PubMed  Google Scholar 

  26. Marks W, Bailey L, Sanger TD (2017) PEDiDBS: The pediatric international deep brain stimulation registry project. Eur J Paediatr Neurol 21:218–22

Download references

Author information

Authors and Affiliations

  1. Division of Neurosurgery, Children’s National Health System, 4th Floor, Suite 100, 111 Michigan Avenue NW, Washington, DC, 20010, USA

    Deki Tsering, Robert F. Keating & Chima O. Oluigbo

  2. Division of Neurology, Children’s National Health System, Washington, DC, USA

    Laura Tochen & Bennett Lavenstein

  3. The George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Bennett Lavenstein, Srijaya K. Reddy, Robert F. Keating & Chima O. Oluigbo

  4. Division of Anesthesiology, Children’s National Health System, Washington, DC, USA

    Srijaya K. Reddy

  5. Division of Neuropsychology, Children’s National Health System, Washington, DC, USA

    Yael Granader

Authors
  1. Deki Tsering
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Tochen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bennett Lavenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Srijaya K. Reddy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yael Granader
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert F. Keating
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chima O. Oluigbo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chima O. Oluigbo.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tsering, D., Tochen, L., Lavenstein, B. et al. Considerations in deep brain stimulation (DBS) for pediatric secondary dystonia. Childs Nerv Syst 33, 631–637 (2017). https://doi.org/10.1007/s00381-017-3361-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-017-3361-x

Keywords

Search

Navigation