Safety Of Deep Brain Stimulation Research Articles

Effectiveness of Deep Brain Stimulation in Parkinsonism

Introduction: Deep brain stimulation (DBS) is a neurosurgical procedure indicated for patients with advanced Parkinson’s disease (PD).This study aimed to investigate the relative efficacy and safety of DBS when medical therapy is ineffective in advanced PD. Material and Method: 50 patients whom were on medical treatment for long and started to have side effects of the drugs were the part of the study to find the improvement in the status in terms of tremors, dyskinesia and rigidity. Results: Preoperatively and postoperatively comparison in the improvement was done which revealed, improvement was 75%, 61.5% and 58 % respectively in tremors, rigidity and dyskinesia. There was statically significantly improvement rigidity, tremor and the dyskinesia, the patients needed smaller doses of the medications and showed less signs of distress. Conclusion: Our results clearly suggested that with Deep Brain Stimulation patients showed significant improvement with decreased dose of medication.

Effectiveness of Deep Brain Stimulation in Parkinsonism

Introduction: Deep brain stimulation (DBS) is a neurosurgical procedure indicated for patients with advanced Parkinson’s disease (PD).This study aimed to investigate the relative efficacy and safety of DBS when medical therapy is ineffective in advanced PD. Material and Method: 50 patients whom were on medical treatment for long and started to have side effects of the drugs were the part of the study to find the improvement in the status in terms of tremors, dyskinesia and rigidity. Results: Preoperatively and postoperatively comparison in the improvement was done which revealed, improvement was 75%, 61.5% and 58% respectively in tremors, rigidity and dyskinesia. There was statically significantly improvement rigidity, tremor and the dyskinesia, the patients needed smaller doses of the medications and showed less signs of distress. Conclusion: Our results clearly suggested that with Deep Brain Stimulation patients showed significant improvement with decreased dose of medication.

Efficacy and Safety of Deep Brain Stimulation in the Treatment of Parkinson's Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Deep brain stimulation (DBS) is a neurosurgical procedure indicated for patients with advanced Parkinson’s disease (PD). Whether similar benefits may be realized by patients with early PD, however, is currently unclear, especially given the potential risks of the procedure. This systematic review and meta-analysis aimed to investigate the relative efficacy and safety of DBS in comparison to best medical therapy (BMT) in the treatment of PD. It also aimed to compare the efficacy of DBS between patients with early and advanced PD.A systematic search was performed in Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials (RCTs) comparing DBS to BMT in PD patients were included. Outcome measures were impairment/disability using the Unified Parkinson’s Disease Rating Scale (UPDRS), quality of life (QoL) using the Parkinson's Disease Questionnaire (PDQ-39), levodopa equivalent dose (LED) reduction, and rates of serious adverse events (SAE).Eight eligible RCTs (n = 1,189) were included in the meta-analysis, two of which recruited early PD patients. Regarding efficacy outcomes, there were significant improvements in UPDRS, PDQ-39, and LED scores in favour of DBS (P < 0.00001). There was a significantly greater reduction of LED in patients with early PD (P < 0.00001), but no other differences between early and advanced PD patients were found. The risk of a patient experiencing an SAE was significantly higher in the DBS group (P = 0.005), as was the total number of SAEs (P < 0.00188).Overall, DBS was superior to BMT at improving impairment/disability, QoL, and reducing medication doses, but these benefits need to be weighed against the higher risk of SAEs. There was insufficient evidence to determine the impact of the PD stage on the efficacy of DBS.

Neurostimulation for drug-resistant epilepsy: a systematic review of clinical evidence for efficacy, safety, contraindications and predictors for response.

Neurostimulation is becoming an increasingly accepted treatment alternative for patients with drug-resistant epilepsy (DRE) who are unsuitable surgery candidates. Standardized guidelines on when or how to use the various neurostimulation modalities are lacking. We conducted a systematic review on the currently available neurostimulation modalities primarily with regard to effectiveness and safety. For vagus nerve stimulation (VNS), there is moderate-quality evidence for its effectiveness in adults with drug-resistant partial epilepsies. Moderate-to-low-quality evidence supports the efficacy and safety of deep brain stimulation (DBS) and responsive neurostimulation (RNS) in patients with DRE. There is moderate-to-very low-quality evidence that transcranial direct current stimulation (tDCS) is effective or well tolerated. For transcutaneous vagus nerve stimulation (tVNS), transcranial magnetic stimulation (TMS) and trigeminal nerve stimulation (TNS), there are insufficient data to support the efficacy of any of these modalities for DRE. These treatment modalities, nevertheless, appear well tolerated, with no severe adverse events reported. Head-to-head comparison of treatment modalities such as VNS, DBS and RNS across different epileptic syndromes are required to decide which treatment modality is the most effective for a given patient scenario. Such studies are challenging and it is unlikely that data will be available in the near future. Additional data collection on potentially promising noninvasive neurostimulation modalities like tVNS, TMS, TNS and tDCS is warranted to get a more precise estimate of their therapeutic benefit and long-term safety.

Efficacy and Safety of Deep Brain Stimulation in Tourette Syndrome

ImportanceCollective evidence has strongly suggested that deep brain stimulation (DBS) is a promising therapy for Tourette syndrome.ObjectiveTo assess the efficacy and safety of DBS in a multinational cohort of patients with Tourette syndrome.Design, Setting, and ParticipantsThe prospective International Deep Brain Stimulation Database and Registry included 185 patients with medically refractory Tourette syndrome who underwent DBS implantation from January 1, 2012, to December 31, 2016, at 31 institutions in 10 countries worldwide.ExposuresPatients with medically refractory symptoms received DBS implantation in the centromedian thalamic region (93 of 163 [57.1%]), the anterior globus pallidus internus (41 of 163 [25.2%]), the posterior globus pallidus internus (25 of 163 [15.3%]), and the anterior limb of the internal capsule (4 of 163 [2.5%]).Main Outcomes and MeasuresScores on the Yale Global Tic Severity Scale and adverse events.ResultsThe International Deep Brain Stimulation Database and Registry enrolled 185 patients (of 171 with available data, 37 females and 134 males; mean [SD] age at surgery, 29.1 [10.8] years [range, 13-58 years]). Symptoms of obsessive-compulsive disorder were present in 97 of 151 patients (64.2%) and 32 of 148 (21.6%) had a history of self-injurious behavior. The mean (SD) total Yale Global Tic Severity Scale score improved from 75.01 (18.36) at baseline to 41.19 (20.00) at 1 year after DBS implantation (P < .001). The mean (SD) motor tic subscore improved from 21.00 (3.72) at baseline to 12.91 (5.78) after 1 year (P < .001), and the mean (SD) phonic tic subscore improved from 16.82 (6.56) at baseline to 9.63 (6.99) at 1 year (P < .001). The overall adverse event rate was 35.4% (56 of 158 patients), with intracranial hemorrhage occurring in 2 patients (1.3%), infection in 4 patients with 5 events (3.2%), and lead explantation in 1 patient (0.6%). The most common stimulation-induced adverse effects were dysarthria (10 [6.3%]) and paresthesia (13 [8.2%]).Conclusions and RelevanceDeep brain stimulation was associated with symptomatic improvement in patients with Tourette syndrome but also with important adverse events. A publicly available website on outcomes of DBS in patients with Tourette syndrome has been provided.

Clinical observation on the effect of deep brain stimulation combined with drug therapy in the treatment of idiopathic Parkinson's disease

Objective To study the efficacy and safety of deep brain stimulation (DBS) combined with drug therapy in the treatment of idiopathic Parkinson's disease (PD). Methods From August 2013 to August 2015, 60 patients with idiopathic PD were enrolled. They were divided into DBS group (N = 30) and control group (N = 30) based on different treatment methods. The control group was given routine drug therapy, while DBS group was given DBS combined with drug therapy. Unified Parkinson's Disease Rating Scale (UPDRS) and Parkinson's Disease Quality of Life Scale (PDQUALIF) were used to evaluate the severity of disease and quality of life. Results In comparison with control group, UPDRS suggested lower mind, behavior and mood score ( P = 0.023), lower activities of daily living score ( P = 0.005), lower motor function score ( P = 0.025), lower motor complications score ( P = 0.008) and lower PDQUALIF score ( P = 0.016) in DBS group. In comparison with scores in DBS group before treatment, UPDRS suggested lower mind, behavior and mood score ( P = 0.003), lower activities of daily living score ( P = 0.016), lower motor function score ( P = 0.001), lower motor complications score ( P = 0.016) and lower PDQUALIF score ( P = 0.000) after treatment. Total effective rate was found higher in DBS group [96.67% (29/30); χ 2 = 5.109, P = 0.000] than that in control group [76.67% (23/30)]. Conclusions DBS combined with drug therapy can effectively improve clinical symptoms and quality of life in patients with idiopathic PD. DOI: 10.3969/j.issn.1672-6731.2017.02.007

Deep brain stimulation for treatment of severe Alzheimer's disease: Study protocol for a prospective, self-controlled, phase I trial (case observation)

Background: With the aging of the global population, an increasing number of people are at risk of developing Alzheimer's disease. There is currently no effective treatment to hinder or postpone the progression of Alzheimer's disease. Cholinesterase inhibitors and the N-methyl-D-aspartate receptor antagonist Memantine are the commonly prescribed drugs for this disease, but their therapeutic effects are still unsatisfactory. Therefore, there is an urgent need to investigate novel treatment methods. Many animal experiments have suggested that deep brain stimulation benefits Alzheimer's disease, but clinical trials investigating this are still in their infancy. This study aims to investigate the safety and effectiveness of deep brain stimulation in the treatment of severe Alzheimer's disease. Methods/Design: This study is a prospective, self-controlled, phase I trial (case observation), which will be performed in the Department of Neurosurgery, Chinese PLA General Hospital (Beijing, China). Six patients with severe Alzheimer's disease will be enrolled to receive continuous bilateral deep brain stimulation of the fornix. Evaluations will be performed at baseline (prior to surgery) and at 1, 6, and 12 months after surgery. The primary outcome measures are disability and mortality rates during the 12-month deep brain stimulation trial period. Secondary outcome measures include the incidence of complications and Clinical Dementia Rating scale, Zarit Caregiver Burden Interview, Mini-Mental State Examination, and Barthel Index of Activities of Daily Living Scale scores. Patient recruitment will begin in August 2017, the analysis of primary outcome measures will be completed in October 2018, and the study will finish in June 2019. Discussion: The results of this study will help to determine the safety of deep brain stimulation for the treatment of severe Alzheimer's disease. We will also assess whether deep brain stimulation can improve the cognition, symptoms, and activities of daily living of patients with Alzheimer's disease. If the study succeeds, a novel option for patients with Alzheimer's disease who respond poorly to current treatments may be provided. Trial registration: The study protocol is registered with ClinicalTrials.gov (identifier: NCT03115814). Ethics: The study protocol was approved by the Ethics Committee of Chinese PLA General Hospital (approval No. S2015-013-02) and will be performed in accordance with the Declaration of Helsinki formulated by the World Medical Association in 2013. Informed consent: Written informed consent will be obtained from each patient's legal representative.

EP 34. Effects of deep brain stimulation of the globus pallidus interna on Huntington’s disease at 1 year

Introduction Huntington’s disease (HD) is an autosomal dominant and progressive neurodegenerative disorder. The disease is caused by a strongly increased number of trinucleotide CAG repeats in the Huntingtin gene and characterized by a progressive loss of striatal neurons. Phenotypically, patients present with severe motor symptoms, such as chorea, dystonia, and bradykinesia. Deep brain stimulation (DBS) of the globus pallidus interna (GPi) has been proposed to treat abnormal movements in HD. Here, we report the clinical outcomes of DBS of the GPi in three HD patients followed for 1 year respectively. Objectives Our main objective was to assess the efficacy and safety of DBS of the GPi in alleviating motor symptoms, particularly chorea. Materials and methods Patients with major functional disability due to pharmacoresistant chorea, preserved or mildly altered cognitive function and no severe psychiatric disorder were selected. Due to the severity of chorea, DBS of the GPi were performed under general anesthesia. Microelectrode recording were also used in the preoperative period in all patients. They were followed for 1 year respectively. Outcome measure were scored by the change of the chorea and total motor scores of the Unified Huntington’s Disease Rating Scale (UHDRS) between pre- and last postoperative assessments. Results Chorea improved in all patients (13%, 86% and 29%) and total motor score decreased in 1 patient (%24) postoperatively. 1 patient had a transient dysarthria because of frontal cerebral contusion after operation. Conclusion Based on these results and previous published reports, DBS of the GPi may be considered as an alternative treatment in non-demented HD patients with severe chorea.

Long-term efficacy and tolerability of bilateral pallidal stimulation to treat tardive dyskinesia.

To confirm the efficacy and safety of deep brain stimulation (DBS) of the internal part of the globus pallidus in improving severe tardive dyskinesia (TD). Nineteen patients with severe pharmacoresistant TD were included. All were assessed at baseline and at 3, 6 (main outcome measure), and 12 months, and in the long term (6-11 years) for 14 patients, after bilateral pallidal DBS, using motor scales (Extrapyramidal Symptoms Rating Scale [ESRS], Abnormal Involuntary Movement Scale [AIMS]), cognitive scales, and a psychiatric assessment. At 6 months, a double-blind ESRS evaluation was performed in the stimulation "on" and stimulation "off" conditions. At 6 months, all patients had a decrease of more than 40% on the ESRS. The efficacy of the procedure was confirmed by a double-blind evaluation. This improvement was maintained at 12 months (ESRS: decrease of 58% [21%-81%]; decrease of 50% [7%-77%]) and in the long term (ESRS: decrease of 60% [22%-90%]; decrease of 63% [14%-94%], n = 14). All the subscores of the ESRS (parkinsonism, dystonia, and chorea) and of the AIMS (facial, oral, extremities, and trunk movements) improved. Despite psychiatric comorbidities at baseline, cognitive and psychiatric tolerability of the procedure was excellent. No cognitive decline was observed and mood was improved in most of the patients. Pallidal DBS procedure should be considered as a therapeutic option in disabling TD refractory to medical treatment. This study provides Class II evidence that in patients with severe pharmacoresistant TD with implanted pallidal leads, the stimulation "on" condition significantly improved ESRS scores compared to the stimulation "off" condition.

A negative randomised sham-controlled trial of ventral capsule/ventral striatum stimulation in treatment-resistant depression: an unsuccessful trial or treatment?

ABSTRACT FROM: Dougherty DD, Rezai AR, Carpenter LL, et al . A randomized sham-controlled trial of deep brain stimulation of the ventral capsule/ventral striatum for chronic treatment-resistant depression. Biol Psychiatry...

Long-term follow-up study on the safety of deep brain stimulation for treating Parkinson's disease

Objective To evaluate the safety of deep brain stimulation (DBS) for treating Parkinson's disease (PD) under long-term follow-up and modify the surgical procedure. Methods A total of 362 PD patients underwent DBS, and almost 613 electrodes were implanted into these patients. Both surgical and hardware-related complications of DBS were retrospectively analyzed. Results Perioperative complications included postoperative confusion or delirium in 21 cases (5.80%), intracranial hemorrhage in 4 cases (1.10%; 2 asymptomatic cortical microhemorrhage and 2 basal ganglia trajectory microhemorrhage), generalized tonic-clonic seizures (GTCS) in 2 cases (0.55% ), urinary tract infection in 4 cases (1.10% ), pulmonary infection in 7 cases (1.93%), implantable pulse generator (IPG) hematoma in 11 cases (3.04%), IPG seroma in 3 cases (0.83%). All these patients were cured. They were followed-up for 12-146 months (median 34 months). Hardware-related complications included infection of incisional wound and/or skin erosion (9 cases, 2.49% ), extension wire fracture caused by IPG displacement (one case, 0.28% ), IPG shifting to abdomen due to fixation wire fracture (one case, 0.28%), slightly migrated electrode due to fall (one case, 0.28%), and discomfort about occipital incision (one case, 0.28%). Conclusions The overall risk of both surgical and hardware-related adverse events of DBS for treating PD is acceptably low. DOI: 10.3969/j.issn.1672-6731.2015.10.005

Corrigendum to ‘Ethical safety of deep brain stimulation: A study on moral decision-making in Parkinson's disease’ [Park. Relat. Disord. 21 (2015) 709–716

Corrigendum to ‘Ethical safety of deep brain stimulation: A study on moral decision-making in Parkinson's disease’ [Park. Relat. Disord. 21 (2015) 709e716] Manuela Fumagalli , Sara Marceglia , Filippo Cogiamanian , Gianluca Ardolino , Marta Picascia , Sergio Barbieri , Gabriella Pravettoni d, , Claudio Pacchetti , Alberto Priori a, f, * a Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy b U.O. Neurofisiopatologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy c Unit a Operativa Parkinson e Disordini del Movimento, IRCCS Istituto Neurologico Mondino, Via Mondino 2, Pavia, Italy d Dipartimento di Economia, Management e Metodi Quantitativi, Universit a degli Studi di Milano, Via Festa del Perdono 7, Milan, Italy e Applied Research Unit for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Via Giuseppe Ripamonti 435, Milan, Italy f Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Universit a degli Studi di Milano, Via Francesco Sforza 35, Milan, Italy

A Prospective Pilot Trial for Pallidal Deep Brain Stimulation in Huntington's Disease.

Movement disorders in Huntington's disease are often medically refractive. The aim of the trial was assessment of procedure safety of deep brain stimulation, equality of internal- and external-pallidal stimulation and efficacy followed-up for 6 months in a prospective pilot trial. In a controlled double-blind phase six patients (four chorea-dominant, two Westphal-variant) with predominant movement disorder were randomly assigned to either the sequence of 6-week internal- or 6-week external-pallidal stimulation, or vice versa, followed by further 3 months chronic pallidal stimulation at the target with best effect-side-effect ratio. Primary endpoints were changes in the Unified Huntington's Disease Rating Scale motor-score, chorea subscore, and total motor-score 4 (blinded-video ratings), comparing internal- versus external-pallidal stimulation, and 6 months versus baseline. Secondary endpoints assessed scores on dystonia, hypokinesia, cognition, mood, functionality/disability, and quality-of-life. Intention-to-treat analysis of all patients (n = 3 in each treatment sequence): Both targets were equal in terms of efficacy. Chorea subscores decreased significantly over 6 months (-5.3 (60.2%), p = 0.037). Effects on dystonia were not significant over the group due to it consisting of three responders (>50% improvement) and three non-responders. Westphal patients did not improve. Cognition was stable. Mood and some functionality/disability and quality-of-life scores improved significantly. Eight adverse events and two additional serious adverse events - mostly internal-pallidal stimulation-related - resolved without sequalae. No procedure-related complications occurred. Pallidal deep brain stimulation was demonstrated to be a safe treatment option for the reduction of chorea in Huntington's disease. Their effects on chorea and dystonia and on quality-of-life should be examined in larger controlled trials.

Ethical safety of deep brain stimulation: A study on moral decision-making in Parkinson's disease.

The possibility that deep brain stimulation (DBS) in Parkinson's disease (PD) alters patients' decisions and actions, even temporarily, raises important clinical, ethical and legal questions. Abnormal moral decision-making can lead to ethical rules violations. Previous experiments demonstrated the subthalamic (STN) activation during moral decision-making. Here we aim to study whether STN DBS can affect moral decision-making in PD patients. Eleven patients with PD and bilateral STN DBS implant performed a computerized moral task in ON and OFF stimulation conditions. A control group of PD patients without DBS implant performed the same experimental protocol. All patients underwent motor, cognitive and psychological assessments. STN stimulation was not able to modify neither reaction times nor responses to moral task both when we compared the ON and the OFF state in the same patient (reaction times, p = .416) and when we compared DBS patients with those treated only with the best medical treatment (reaction times: p = .408, responses: p = .776). Moral judgment is the result of a complex process, requiring cognitive executive functions, problem-solving, anticipations of consequences of an action, conflict processing, emotional evaluation of context and of possible outcomes, and involving different brain areas and neural circuits. Our data show that STN DBS leaves unaffected moral decisions thus implying relevant clinical and ethical implications for DBS consequences on patients' behavior, on decision-making and on judgment ability. In conclusion, the technique can be considered safe on moral behavior.

Long-term outcome of deep brain stimulation in fragile X-associated tremor/ataxia syndrome.

Fragile X-associated tremor/ataxia syndrome (FXTAS) presents as complex movement disorder including tremor and cerebellar ataxia. The efficacy and safety of deep brain stimulation of the nucleus ventralis intermedius of the thalamus in atypical tremor syndromes like FXTAS remains to be determined. Here, we report the long-term outcome of three male genetically confirmed FXTAS patients treated with bilateral neurostimulation of the nucleus ventralis intermedius for up to four years. All patients demonstrated sustained improvement of both tremor and ataxia - the latter included improvement of intention tremor and axial tremor. Kinematic gait analyses further demonstrated a regularization of the gait cycle. Initial improvements of hand functional disability were not sustained and reached the preoperative level of impairment within one to two years from surgery. Our data on patients with a genetic cause of tremor show favorable outcome and may contribute to improved patient stratification for neurostimulation therapy in the future.

Mood Stability in Parkinson Disease Following Deep Brain Stimulation: A 6-Month Prospective Follow-up Study

Deep brain stimulation for Parkinson disease has been associated with psychiatric adverse effects including anxiety, depression, mania, psychosis, and suicide. The purpose of this study was to evaluate the safety of deep brain stimulation in a large Parkinson disease clinical practice. Patients approved for surgery by the Mayo Clinic deep brain stimulation clinical committee participated in a 6-month prospective naturalistic follow-up study. In addition to the Unified Parkinson's Disease Rating Scale, stability and psychiatric safety were measured using the Beck Depression Inventory, Hamilton Depression Rating Scale, and Young Mania Rating scale. Outcomes were compared in patients with Parkinson disease who had a psychiatric history to those with no co-morbid psychiatric history. The study was completed by 49 of 54 patients. Statistically significant 6-month baseline to end-point improvement was found in motor and mood scales. No significant differences were found in psychiatric outcomes based on the presence or absence of psychiatric comorbidity. Our study suggests that patients with Parkinson disease who have a history of psychiatric co-morbidity can safely respond to deep brain stimulation with no greater risk of psychiatric adverse effect occurrence. A multidisciplinary team approach, including careful psychiatric screening ensuring mood stabilization and psychiatric follow-up, should be viewed as standard of care to optimize the psychiatric outcome in the course of deep brain stimulation treatment.

Symptomatic Treatment of Memory Decline in Alzheimer's Disease by Deep Brain Stimulation: A Feasibility Study

Recent studies have suggested that memory circuits can be modulated by deep brain stimulation (DBS). This propriety might be used to slow down cognitive decline in patients suffering from Alzheimer's disease (AD). We conducted a prospective study to evaluate the feasibility and safety of DBS in AD patients with mild cognitive decline. Inclusion criteria were: patients (<70 years old) with AD diagnosed for less than 2 years, predominant impairment of episodic memory, and Mini-Mental Status Exam (MMSE) score between 20 and 24. The fornix was stimulated bilaterally by electrodes implanted stereotactically in the hypothalamus. Clinical, biological, neuropsychological, and imaging evaluations were conducted 3 months before surgery and 3, 6, and 12 months thereafter. During the one year-period of inclusion, 110 patients with recently diagnosed AD and predominant impairment of episodic memory were screened. Only 9 patients (8.2%) fulfilled all the inclusion criteria. Finally, just one patient accepted to be operated (acceptance rate 11.1%) and completed the study. No complications occurred and the stimulation was perfectly tolerated. After one year of stimulation, the memory scores (MMSE, ADAS-Cog, Free and Cued Selective Reminding Test) were stabilized compared to baseline, and mesial temporal lobes metabolism increased. This pilot study provides new data about the safety of fornix DBS in the hypothalamus. However, it suggests that only a small proportion of AD patients might be interested in this approach and that the acceptance of DBS by AD patients was low, raising questions about the relevance of this approach to meet the expectations of these patients.

The Cognitive Safety of Deep Brain Stimulation in Refractory Psychiatric Disorders

The Cognitive Safety of Deep Brain Stimulation in Refractory Psychiatric Disorders

The cognitive safety of deep brain stimulation in refractory psychiatric disorders.

The cognitive safety of deep brain stimulation in refractory psychiatric disorders.

Deep Brain Stimulation in Children with Dystonia: Experience from a Tertiary Care Center

Objective: To investigate the efficacy and safety of deep brain stimulation (DBS) of the globus pallidus internus (GPi) in children with dystonia. Methods: Retrospective chart review of patients (≤21 years) with dystonia who underwent GPi DBS. Outcome measures were assessed by the Burke-Fahn-Marsden Dystonia Rating (BFMDR) movement and disability scales pre- and post-DBS. Results: Eight patients underwent DBS; mean age of onset was 7.5 ± 4.8 years (7 were male). Mean age at DBS was 14.1 ± 4.6 years. Etiology of dystonia was primary in 6 patients and secondary in 2. There was significant improvement of BFMDR movement as well as BFMDR disability scales in 6 patients with primary dystonia with modest improvement in those scales in 2 patients with secondary dystonia. Hardware-related problems were observed in 2 and infection was noted in 1. Conclusions: GPi DBS is an effective and safe therapy in pediatric patients with primary as well as selected cases of secondary dystonia.