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Child's Nervous System

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01-09-2018 | Original Paper

DBS in pediatric patients: institutional experience

Authors: Huseyin Canaz, Isik Karalok, Baris Topcular, Mert Agaoglu, Zuhal Yapici, Sabri Aydin

Published in: Child's Nervous System | Issue 9/2018

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.

Lipsman N, Ellis M, Lozano AM (2010) Current and future indications for deep brain stimulation in pediatric populations. Neurosurg Focus 29(2):E2. https://doi.org/10.3171/2010.5.FOCUS1095 CrossRefPubMed

Cif L, Coubes P (2017) Historical developments in children’s deep brain stimulation. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society 21(1):109–117. https://doi.org/10.1016/j.ejpn.2016.08.010 CrossRef

Olaya JE, Christian E, Ferman D, Luc Q, Krieger MD, Sanger TD, Liker MA (2013) Deep brain stimulation in children and young adults with secondary dystonia: the Children’s Hospital Los Angeles experience. Neurosurg Focus 35(5):E7. https://doi.org/10.3171/2013.8.FOCUS13300 CrossRefPubMed

Comella CL, Leurgans S, Wuu J, Stebbins GT, Chmura T, Dystonia Study G (2003) Rating scales for dystonia: a multicenter assessment. Movement disorders : official journal of the Movement Disorder Society 18(3):303–312. https://doi.org/10.1002/mds.10377 CrossRef

Busner J, Targum SD (2007) The clinical global impressions scale: applying a research tool in clinical practice. Psychiatry 4(7):28–37PubMedPubMedCentral

Leckman JF, Riddle MA, Hardin MT, Ort SI, Swartz KL, Stevenson J, Cohen DJ (1989) The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 28(4):566–573. https://doi.org/10.1097/00004583-198907000-00015 CrossRefPubMed

DiFrancesco MF, Halpern CH, Hurtig HH, Baltuch GH, Heuer GG (2012) Pediatric indications for deep brain stimulation. Child’s nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 28(10):1701–1714. https://doi.org/10.1007/s00381-012-1861-2 CrossRef

Fahn S (2011) Classification of movement disorders. Movement disorders : official journal of the Movement Disorder Society 26(6):947–957. https://doi.org/10.1002/mds.23759 CrossRef

Bhidayasiri R (2006) Dystonia: genetics and treatment update. Neurologist 12(2):74–85. https://doi.org/10.1097/01.nrl.0000195831.46000.2d CrossRefPubMed

10.

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, Deep-Brain Stimulation for Dystonia Study G (2006) Pallidal deep-brain stimulation in primary generalized or segmental dystonia. N Engl J Med 355(19):1978–1990. https://doi.org/10.1056/NEJMoa063618 CrossRefPubMed

11.

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 (9):1748–1751. doi:https://doi.org/10.1002/mds.23723

12.

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(6):585–593. https://doi.org/10.3171/2014.8.PEDS141 CrossRefPubMed

13.

Lobel U, Schweser F, Nickel M, Deistung A, Grosse R, Hagel C, Fiehler J, Schulz A, Hartig M, Reichenbach JR, Kohlschutter A, Sedlacik J (2014) Brain iron quantification by MRI in mitochondrial membrane protein-associated neurodegeneration under iron-chelating therapy. Annals of clinical and translational neurology 1(12):1041–1046. https://doi.org/10.1002/acn3.116 CrossRefPubMedPubMedCentral

14.

Yilmaz S, Gokben S, Ceylaner S (2015) Mitochondrial membrane protein-associated neurodegeneration. Pediatr Neurol 53(4):373–374. https://doi.org/10.1016/j.pediatrneurol.2015.06.012 CrossRefPubMed

15.

Schneider SA, Dusek P, Hardy J, Westenberger A, Jankovic J, Bhatia KP (2013) Genetics and pathophysiology of neurodegeneration with brain iron accumulation (NBIA). Curr Neuropharmacol 11(1):59–79. https://doi.org/10.2174/157015913804999469 PubMedPubMedCentralCrossRef

16.

Mahoney R, Selway R, Lin JP (2011) Cognitive functioning in children with pantothenate-kinase-associated neurodegeneration undergoing deep brain stimulation. Dev Med Child Neurol 53(3):275–279. https://doi.org/10.1111/j.1469-8749.2010.03815.x CrossRefPubMed

17.

Aydin S, Abuzayed B, Uysal S, Unver O, Uzan M, Mengi M, Kizilkilic O, Hanci M (2013) Pallidal deep brain stimulation in a 5-year-old child with dystonic storm: case report. Turkish neurosurgery 23(1):125–128. https://doi.org/10.5137/1019-5149.JTN.4579-11.0 PubMedCrossRef

18.

Schrock LE, Mink JW, Woods DW, Porta M, Servello D, Visser-Vandewalle V, Silburn PA, Foltynie T, Walker HC, Shahed-Jimenez J, Savica R, Klassen BT, Machado AG, Foote KD, Zhang JG, Hu W, Ackermans L, Temel Y, Mari Z, Changizi BK, Lozano A, Auyeung M, Kaido T, Agid Y, Welter ML, Khandhar SM, Mogilner AY, Pourfar MH, Walter BL, Juncos JL, Gross RE, Kuhn J, Leckman JF, Neimat JA, Okun MS, Tourette Syndrome Association International Deep Brain Stimulation D, Registry Study G (2015) Tourette syndrome deep brain stimulation: a review and updated recommendations. Movement disorders : official journal of the Movement Disorder Society 30(4):448–471. https://doi.org/10.1002/mds.26094 CrossRef

19.

Thomsen TR, Rodnitzky RL (2010) Juvenile parkinsonism: epidemiology, diagnosis and treatment. CNS drugs 24(6):467–477. https://doi.org/10.2165/11533130-000000000-00000 CrossRefPubMed

20.

Genc G, Apaydin H, Gunduz A, Poyraz C, Oguz S, Yagci S, Canaz H, Aydin S, Gundogdu-Eken A, Basak AN, Ertan S (2016) Successful treatment of juvenile parkinsonism with bilateral subthalamic deep brain stimulation in a 14-year-old patient with parkin gene mutation. Parkinsonism Relat Disord 24:137–138. https://doi.org/10.1016/j.parkreldis.2016.01.018 CrossRefPubMed

21.

Courchesne E, Chisum HJ, Townsend J, Cowles A, Covington J, Egaas B, Harwood M, Hinds S, Press GA (2000) Normal brain development and aging: quantitative analysis at in vivo MR imaging in healthy volunteers. Radiology 216(3):672–682. https://doi.org/10.1148/radiology.216.3.r00au37672 CrossRefPubMed

Title: DBS in pediatric patients: institutional experience
Authors: Huseyin Canaz
Isik Karalok
Baris Topcular
Mert Agaoglu
Zuhal Yapici
Sabri Aydin
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 9/2018
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-018-3839-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

DBS in pediatric patients: institutional experience

Abstract

Introduction

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Conclusion

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