Deep brain stimulation in pediatric dystonia: calls for therapeutic realism over nihilism.

Abstract

Pediatric dystonia (PD) has a significant negative impact on the growth and development of the child. This study was done retrospectively to analyze functional outcomes in pediatric patients with dystonia who underwent deep brain stimulation. In this retrospective analytical study, all the patients of age less than 18years undergoing deep brain stimulation (DBS) for dystonia between 2012 and 2020 in a single center were analyzed and their functional outcomes were measured by the Burke-Fahn-Marsden-dystonia-rating-scale (BFMDRS). A total of 10 pediatric patients were included with a mean age of onset, duration of disease, and age at surgery being 5.75years, 7.36years, and 13.11years, respectively, with a mean follow-up of 23.22months. The mean pre-DBS motor score was 75.44 ± 23.53 which improved significantly at 6-month and 12-month follow-up to 57.27 (p value 0.004) and 50.38 (p value < 0.001), respectively. Limbs sub-scores improved significantly at both the scheduled intervals. There was a significant improvement in disability at 1-year follow-up with significant improvement in feeding, dressing, and walking components. There was a 27.34% and 36.64% improvement in dystonia with a 17.37% and 28.86% reduction in disability at 6months and 12months, respectively. There was a positive correlation between the absolute reduction of the motor score and improvement in disability of the patients at 6months (rho = 0.865, p value 0.003). DBS in PD has an enormous role in reducing disease burden and achieving a sustainable therapeutic goal.