Deep Brain Stimulation for Pediatric Dystonia: A Review of the Literature and Suggested Programming Algorithm

Author:

Gelineau-Morel Rose1ORCID,Kruer Michael C.2,Garris Jordan F.3,Abu Libdeh Amal3ORCID,Barbosa Daniel A. N.4,Coffman Keith A.1ORCID,Moon David5,Barton Christopher67,Zea Vera Alonso8,Bruce Adrienne B.910,Larsh Travis1112ORCID,Wu Steve W.1112,Gilbert Donald L.1112ORCID,O’Malley Jennifer A.13

Affiliation:

1. Division of Neurology, Department of Pediatrics, Children’s Mercy Hospital, University of Missouri–Kansas City School of Medicine, Kansas City, MO, USA

2. Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children’s Hospital & University of Arizona College of Medicine–Phoenix, Phoenix, AZ, USA

3. Division of Pediatric Neurology, Department of Neurology, University of Virginia, Charlottesville, VA, USA

4. Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA

5. Department of Child Neurology, Division of Neurosciences, Helen DeVos Children’s Hospital, Grand Rapids, MI, USA

6. Department of Neurology, University of Louisville School of Medicine, Louisville, KY, USA

7. Division of Child Neurology, Norton Children’s Medical Group, Louisville, KY, USA

8. Department of Neurology, Children’s National Hospital, Washington, DC, USA

9. Division of Pediatric Neurology, Department of Pediatrics, Prisma Health, Greenville, SC, USA

10. University of South Carolina School of Medicine Greenville, Greenville, SC, USA

11. Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

12. Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA

13. Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA, USA

Abstract

Deep brain stimulation (DBS) is an established intervention for use in pediatric movement disorders, especially dystonia. Although multiple publications have provided guidelines for deep brain stimulation patient selection and programming in adults, there are no evidence-based or consensus statements published for pediatrics. The result is lack of standardized care and underutilization of this effective treatment. To this end, we assembled a focus group of 13 pediatric movement disorder specialists and 1 neurosurgeon experienced in pediatric deep brain stimulation to review recent literature and current practices and propose a standardized approach to candidate selection, implantation target site selection, and programming algorithms. For pediatric dystonia, we provide algorithms for (1) programming for initial session and follow-up sessions, and (2) troubleshooting side effects encountered during programming. We discuss common side effects, how they present, and recommendations for management. This topical review serves as a resource for movement disorders specialists interested in using deep brain stimulation for pediatric dystonia.

Funder

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Publisher

SAGE Publications

Subject

Neurology (clinical),Pediatrics, Perinatology and Child Health

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