Complications of Deep Brain Stimulation (DBS) for dystonia in children – The challenges and 10 year experience in a large paediatric cohort

Abstract

Please cite this article as: Kaminska M, Perides S, Lumsden DE, Nakou V, Selway R, Ashkan K, Lin J-P, Complications of Deep Brain Stimulation (DBS) for dystonia in children -the challenges and 10 year experience in a large paediatric cohort, European Journal of Paediatric Neurology (2016Neurology ( ), doi: 10.1016Neurology ( / j.ejpn.2016 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. • Lower than previously reported infection rates following DBS for movement disorders in children were identified and no increased susceptibility for patients younger than 7 years. • We report relatively high incidence of technical problems with electrodes and extensions and in particular recharging.• Presentation of heterogeneous phenotypes requires an experienced team to manage and prevent complications. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPTThe paper confirms that DBS in young children is safe and can be offered. Abstract:Deep brain stimulation (DBS) has been increasingly used for primary and secondary movement disorders in children and young people. Reports of hardware related complications have been sparse for this population and from small cohorts of patients.We report DBS complications from a single large DBS centre with 10 year experience.Data was collected as a prospective audit and additionally from a questionnaire on recharging of the stimulators. 129 patients with a minimum 6 months follow up were identified, mean age10.8 y (range 3.0 -18.75), mean follow up 3.3y (range 0.5 -10.3), weight 10.4-94.2kg, 126 new implants (92 Activa RC) and 69 revisions for reasons other than infection. 26 patients were 7y or younger. Surgical site infections (SSI) rates were 10.3% for new implants and revisions, lower 8.6% for new Activa RC and even lower, 4.7%, for new Activa RC in patients under 7y (1/21). SSI occurred within first 6 months and necessitated total system removal in 86% of those infected. Electrode/extension problems were recorded in 18.4% of patients, fracture in 4.6% malfunction in 7.7%, short extension3.8% and electrode migration in 2.3%. Other complications involved clinically silent intracranial bleed in 1 patient, skin erosions (2.3%), unexpected switching off in 18.7% of Soletra/Kinetra and 3.4% of Activa RC, transient seroma at IPG site in postoperative period (8%). Of the 48 returned recharging questionnaires, 38% of families required recharger replacement and 23% experienced frequent problems maintaining connection during recharging. However, 83% of responders considered recharging not at all or only a little care burden.We identified lower than previously reported DBS infection rates ...

Deep brain stimulation for pantothenate kinase‐associated neurodegeneration: A meta‐analysis

“…The complication rate of DBS in children and adults with PKAN appears in line with other types of dystonia . Infections were more frequent in younger patients.…”

“…The complication rate of DBS in children and adults with PKAN appears in line with other types of dystonia. [33][34][35] Infections were more frequent in younger patients. The overall infection rate appeared higher in patients operated on in status dystonicus.…”

Deep brain stimulation for pediatric dystonia: a meta‐analysis with individual participant data

“…Despite these numbers, no permanent sequalae pertaining to DBS infection was reported. Another 69 revisions were noted, mostly due to battery changes, highlighting relatively high rates of technical problems . Complication rates of DBS in the pediatric population may be high, but should also be interpreted with knowledge of higher rates of complications in children than adults for other implant procedures, such as ventriculoperitoneal shunting …”

Pharmacological and neurosurgical interventions for managing dystonia in cerebral palsy: a systematic review

“…There was insufficient evidence to make a recommendation for its use in improving motor control, relieving pain, or easing caregiving. 75 These sparse data, including a recent meta-analysis of DBS in CP, 76 nevertheless indicate that DBS neuromodulation could be beneficial for dystonic CP, but it must be emphasized that more studies, with larger numbers of cases with a more homogeneous age at DBS surgery and improved selection criteria, are needed to capture information relating to dystonia severity, pain, motor function, and caregiver burden, rather than focusing on dystonia reduction alone. 21,62,77,78 Studying the early provision of DBS in dystonic CP at a time when 'critical' and 'sensitive' windows for cerebral plasticity are still open may resolve the issue of whether better dystonia reduction, as well as better motor function and reduction in musculoskeletal deformity, can be achieved.…”