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DBS in pediatric patients: institutional experience

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Abstract

Introduction

DBS is initially used for treatment of essential tremor and Parkinson’s disease in adults. In 1996, a child with severe life-threatening dystonia was offered DBS to the internal globus pallidus (GPi) with lasting efficacy at 20 years. Since that time, increasing number of children benefited from DBS.

Patients and methods

We retrospectively evaluated our database of patients who underwent DBS from 2011 to 2017. All patients ≤ 17 years of age at the time of implantation of DBS were included in this series. Subjective Benefit Rating Scale (SBRS), Hoehn Yahr Scale (HYS), Fahn Marsden Rating Scale (FMRS), Clinical Global Impressions Scales (CGI), and Yale Global Tic Severity Scale (YGT) were used to evaluate clinical outcome.

Results

Between May 2014 and October 2017, 11 children underwent DBS procedure in our institution. Six of them were female and five of them were male. Mean age at surgery was 11.8 ± 4.06 years (range 5–17 years). In our series, four patients had primary dystonia (PDY) (36.3%), three patients had secondary dystonia (SDY) (27.2%), two patients had JP (18.1%), and two patients had Tourette Syndrome (TS) (18.1%). Two JP patients underwent bilateral STN DBS while the other nine patients underwent bilateral GPi DBS. SBRS scores were 1.75 ± 0.5 for patients with PDY, 3 ± 0 for patients with JP, 2.5 ± 0.7 for patients with TS, and 2 ± 1 for patients with SDY. Mean FMRS reduction rate was 40.5 for patients with dystonia. Significant improvement was also defined in patients with TS and JP after DBS. None of the patients experienced any intracerebral hemorrhage or other serious adverse neurological effect related to the DBS. Wound complications occurred in two patients.

Conclusion

There are many literatures that support DBS as a treatment option for pediatric patients with medically refractory neurological disorders. DBS has replaced ablative procedures as a treatment of choice not only for adult patients, but also for pediatric patients. Wound-related complications still remain the most common problem in pediatric patients. Development of smaller and more flexible hardware will improve quality of children’s life and minimize wound-related complications in the future.

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Abbreviations

AC:

anterior commissure

ADHD:

attention-deficit hyperactivity disorder

CGI:

Clinical Global Impressions Scales

Cm–PoF:

centromedian–parafascicular nuclear complex of the thalamus

CP:

cerebral palsy

CT:

computerized tomography

DBS:

deep brain stimulation

FMRS:

Fahn Marsden Rating Scale

GPi:

internal globus pallidus

HYS:

Hoehn Yahr Scale

ICU:

intensive care unit

JP:

juvenile parkinsonism

MER:

microelectrode recording;

MPAN:

mitochondrial membrane protein-associated neurodegeneration

MRI:

magnetic resonance imaging

NAc:

nucleus accumbens

NBIA:

neurodegeneration with brain iron accumulation

OCD:

obsessive compulsive disorder

PC:

posterior commissure

PD:

Parkinson’s disease

PDY:

primary dystonia

PGD:

primary generalized dystonia

PINK1:

PTEN-induced putative kinase 1

PKAN:

pantothenate-kinase-associated neurodegeneration

SBRS:

Subjective Benefit Rating Scale

SDY:

secondary dystonia

STN:

subthalamic nucleus

TS:

Tourette syndrome

YGT:

Yale Global Tic Severity Scale

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Authors and Affiliations

  1. Department of Neurosurgery, Florence Nightingale Hospital, Istanbul Bilim University, Abide-i Hurriyet Cad. No:164 Sisli, Istanbul, Turkey

    Huseyin Canaz & Sabri Aydin

  2. Department of Radiology, Istanbul Bilim University, Istanbul, Turkey

    Isik Karalok

  3. Department of Neurology, Istanbul Bilim University, Istanbul, Turkey

    Baris Topcular

  4. Medtronic, Istanbul, Turkey

    Mert Agaoglu

  5. Division of Pediatric Neurology, Department of Neurology, Istanbul University, Istanbul, Turkey

    Zuhal Yapici

Authors
  1. Huseyin Canaz
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  2. Isik Karalok
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  3. Baris Topcular
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  4. Mert Agaoglu
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  6. Sabri Aydin
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Correspondence to Huseyin Canaz.

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This study was approved by the institutional review board of Istanbul Bilim University, Istanbul, Turkey.

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Canaz, H., Karalok, I., Topcular, B. et al. DBS in pediatric patients: institutional experience. Childs Nerv Syst 34, 1771–1776 (2018). https://doi.org/10.1007/s00381-018-3839-1

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