Rechargeable Deep Brain Stimulators in the Management of Paediatric Dystonia: Well Tolerated with a Low Complication Rate

Abstract

Background: Deep brain stimulation (DBS) is a recognised method of treatment for primary and secondary dystonia. The size of non-rechargeable batteries has limited their use in small children. Our severe dystonia patients have required battery replacement every 20–24 months. Objectives: To evaluate reliability, care burden, patients’ satisfaction and complications related to the rechargeable neurostimulator Activa® RC (launched by Medtronic in Europe in autumn 2008). Methods: Complications were recorded prospectively, and a questionnaire on neurostimulator maintenance, care burden and parental satisfaction was applied to all patients with at least 3 months of follow-up. Results: 30 Activa RCs were implanted between December 2008 and June 2010, 25 with a follow-up of 3–17 months (mean 10); the mean patient’s age at surgery was 11.1 years; 22/25 questionnaires were completed. All families achieved good standards of recharging. Caregivers were responsible for recharging in 82% of cases. With higher parameters of stimulation, recharging time was longer than initially recommended by the manufacturer. All but one family would recommend Activa RC to other patients. Transient recharging problems were the most common complication (36% of cases). Infection/skin erosion occurred in 8% of cases, self-resolving early seroma in 20%. Conclusions: Activa was found to offer reliable stimulation with a low rate of significant complications and a suitable treatment option for children with dystonia.

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

“…However, a third of families required a recharger replacement and a fifth had frequent difficulty maintaining connection between the recharger and the battery. As previously reported 37 the majority of carers did not use the harness or belt supplied by the manufacturer as they were not suitable either due to patient small size or severe dystonic/dyskinetic movements.…”

What parents think and feel about deep brain stimulation in paediatric secondary dystonia including cerebral palsy: A qualitative study of parental decision-making

“…Given the variability of outcomes in secondary dystonia, and growing evidence that impairment measures are not sensitive enough to detect small but significant changes 14 a greater understanding how parents experience and manage DBS decision-making would be valuable. The decision to undertake DBS for families with secondary dystonia comprises a combination of unique factors: children with variable cognitive and communication abilities (see Owen EJPN This edition), a lack of outcome certainty, a long term commitment to regular hospital follow up appointments and a daily commitment to battery charging 18 . Little is known about how these factors influence the decision to undergo DBS surgery.…”

Deep Brain Stimulator insertion: What should we know as anaesthetists?

“…Fixed life batteries tend to be most widely used in adults whilst rechargeable ones are preferred in the paediatric population. 20 The fixed life battery usually lasts about 3-5 years. Anaesthesia for battery change is a relatively simple procedure.…”