DBS in pediatric patients: institutional experience

Canaz, Huseyin; Karalök, Işık; Topçular, Barış; Agaoglu, Mert; Yapıcı, Zühal; Aydın, Sabri

doi:10.1007/s00381-018-3839-1

Cited by 19 publications

(21 citation statements)

References 20 publications

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“…Alternatively, a combination of dexmedetomidine and propofol or remifentanil and ketamine can be safely used to obtain adequate sedation and analgesia without respiratory depression [53], preserving microelectrode recordings and awake cooperation with intraoperative testing [50]. In those cases where asleep placement is preferred, frame-based stereotactic surgery is performed without microelectrode recordings and [20] (3) Idiopathic Unknown [20,26,30,51,73,115,116,121,131] [35] Vo [51] VIM [51] VA [51] VLp [51] GPi, globus pallidus internus; STN, subthalamic nucleus; PKAN, pantothenate kinase-associated neurodegeneration; NBIA, neurodegeneration with brain iron accumulation; VLp, ventral posterolateral nucleus; Vo, ventral oral nucleus; VIM, ventral intermediate nucleus; VA, ventral anterior nucleus.…”

Section: Surgical Considerations In Pediatric Dbsmentioning

confidence: 99%

Long-Term Outcomes of Deep Brain Stimulation for Pediatric Dystonia

Malatt

Tagliati²

2022

Pediatr Neurosurg

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Background Deep brain stimulation (DBS) has been utilized for over two decades to treat medication refractory dystonia in children. Short-term benefit has been demonstrated for inherited, isolated and idiopathic cases, with less efficacy in heredodegenerative and acquired dystonias. The ongoing publication of long-term outcomes warrants a critical assessment of available information as pediatric patients are expected to live most of their lives with these implants. Summary We performed a review of the literature for data describing motor and neuropsychiatric outcomes, in addition to complications, five or more years after DBS placement in patients undergoing DBS surgery for dystonia at an age younger than 21. We identified 20 articles including individual data on long-term motor outcomes after DBS for a total of 78 patients. In addition, we found five articles reporting long-term outcomes after DBS in nine patients with status dystonicus. The majority of patients were implanted within the globus pallidus internus, with only a few cases targeting the subthalamic nucleus and ventrolateral posterior nucleus of the thalamus. The average follow-up was 8.5 years, with a range up to 22 years. Long-term outcomes showed a sustained motor benefit, with median Burke-Fahn-Marsden dystonia rating score improvement ranging from 2.5% to 93.2% in different dystonia subtypes. Patients with inherited, isolated and idiopathic dystonias had greater improvement than those with heredodegenerative and acquired dystonias. Sustained improvements in quality of life were also reported, without the development of significant cognitive or psychiatric co-morbidities. Late adverse events tended to be hardware-related, with minimal stimulation-induced effects. Key Messages While data regarding long-term outcomes is somewhat limited, particularly with regards to neuropsychiatric outcomes and adverse events, improvement in motor outcomes appear to be preserved more than 5 years after DBS placement.

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Section: Surgical Considerations In Pediatric Dbsmentioning

confidence: 99%

Long-Term Outcomes of Deep Brain Stimulation for Pediatric Dystonia

Malatt

Tagliati²

2022

Pediatr Neurosurg

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“…However, in an open-label, follow-up study, 75% of patients had an average 70% tic reduction in the YGTSS total score after 48 months 125 . Posteroventral GPi DBS has also been reported 126 . In addition to the GPi, the thalamus, globus pallidus externus, anterior limb of the internal capsule, and nucleus accumbens have been suggested as targets for DBS for tics 127 .…”

Section: Treatmentmentioning

confidence: 99%

Recent progress on Tourette syndrome

Ueda¹,

Black²

2021

Fac Rev

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Tic disorders and Tourette syndrome are the most common movement disorders in children and are characterized by movements or vocalizations. Clinically, Tourette syndrome is frequently associated with comorbid psychiatric symptoms. Although dysfunction of cortical–striatal–thalamic–cortical circuits with aberrant neurotransmitter function has been considered the proximate cause of tics, the mechanism underlying this association is unclear. Recently, many studies have been conducted to elucidate the epidemiology, clinical course, comorbid symptoms, and pathophysiology of tic disorders by using laboratory studies, neuroimaging, electrophysiological testing, environmental exposure, and genetic testing. In addition, many researchers have focused on treatment for tics, including behavioral therapy, pharmacological treatment, and surgical treatment. Here, we provide an overview of recent progress on Tourette syndrome.

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“…In total, one systematic review 15 was included plus eight case series studies [36][37][38][39][40][41][42][43] and six case reports [44][45][46][47][48][49] published after the systematic review, all of which represented level IV evidence. The systematic review by Elkaim et al 15 summarised data on the effectiveness of DBS for 321 paediatric patients with dystonia from 72 unique primary studies (level IV evidence); the median follow up ranged from 11 to 20 months.…”

Section: Included Studiesmentioning

confidence: 99%

“…Four case series studies [37][38][39]42 and four case reports 44,[47][48][49] published after Elkaim et al 15 documented safety and effectiveness outcomes in a total of 151 patients (range 4-19 years) receiving DBS for various dystonia aetiologies. Bilateral DBS of the GPi was undertaken in 92% of patients, with a postoperative follow up ranging from six months to a mean of 4.6 years.…”

Section: Included Studiesmentioning

confidence: 99%

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Paediatric deep brain stimulation

Scott¹,

Duncan²,

Tivey³

et al. 2019

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This review aimed to assess the evidence around the use of deep brain stimulation (DBS) for paediatric patients with severe dystonia. It aimed to answer the following questions: 1) Is paediatric DBS safe, efficacious and cost effective when compared with best supportive care?, 2) Is DBS more safe or more effective for some types of paediatric dystonia than others? Are there agreed patient selection criteria?, 3) What models of care and service delivery or access and funding mechanisms are established to deliver paediatric DBS internationally?. The available evidence is limited but the growing body of level IV evidence generally supports use of DBS for improving motor function and disability. More data is needed that looks as other aspects of patient wellbeing.

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DBS in pediatric patients: institutional experience

Cited by 19 publications

References 20 publications

Long-Term Outcomes of Deep Brain Stimulation for Pediatric Dystonia

Long-Term Outcomes of Deep Brain Stimulation for Pediatric Dystonia

Recent progress on Tourette syndrome

Paediatric deep brain stimulation

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