Artikel
Directional deep brain stimulation of the globus pallidus internus in treatment of childhood dystonia
Verwendung segmentierter DBS Elektroden für die direktionelle Stimulation des Globus pallidus internus zur Behandlung der Dystonie im Kindesalter
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Autoren
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Maria Abel
- Schön-Klinik Vogtareuth, Fachzentrum für Neurochirurgie und Epilepsiechirurgie, Wirbelsäulen- und Skoliosezentrum, Vogtareuth, Deutschland
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Suleiman Nauros
- Schön-Klinik Vogtareuth, Fachzentrum für Neurochirurgie und Epilepsiechirurgie, Wirbelsäulen- und Skoliosezentrum, Vogtareuth, Deutschland
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Manfred Kudernatsch
- Schön-Klinik Vogtareuth, Fachzentrum für Neurochirurgie und Epilepsiechirurgie, Wirbelsäulen- und Skoliosezentrum, Vogtareuth, Deutschland
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Robert Pfister
- Schön-Klinik Vogtareuth, Fachzentrum für Neurochirurgie und Epilepsiechirurgie, Wirbelsäulen- und Skoliosezentrum, Vogtareuth, Deutschland
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Steffen Berweck
- Schön-Klinik Vogtareuth, Fachzentrum für Pädiatrische Neurologie, Neurorehabilitation und Epileptologie, Vogtareuth, Deutschland
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Walter Demmel
- Schön-Klinik Vogtareuth, Fachzentrum für Neurochirurgie und Epilepsiechirurgie, Wirbelsäulen- und Skoliosezentrum, Vogtareuth, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
Text
Objective: In generalized dystonia, bilateral deep brain stimulation of the globus pallidus internus (GPi-DBS) is reported to be an efficient therapeutic option [1]. As the commonly used quadripole cylindrical lead originates electrical current in all directions, inadvertent spreading to adjacent structures may cause stimulation-induced side effects. With the addition of directional elements and the use of eight contacts, more precise GPi-DBS stimulation programming is available [2], [3]. Reports about directional stimulation in GPi-DBS treating dystonia are scarce. Here, we report our experience using segmented DBS leads for treatment of childhood dystonia.
Methods: The institutional data base was retrospectively reviewed since the first child with dystonia was treated with GPi-DBS in our institution in 2019. All patients suffering from severe dystonia who were treated with GPi-DBS using segmented DBS leads were included in this case series.
Results: Four patients with severe generalized dystonia who were treated with GPi-DBS in our institution were identified. The mean age of patients was 11.4 years (range 8 - 18 years). In all cases, segmented DBS leads were implanted under general anesthesia. The underlying cause of dystonia included genetic etiology of dystonia (n=2), hypoxic encephalopathy (n=1) and idiopathic dystonia (n=1). Three patients had an excellent response, whereas one child only showed partial response to GPi-DBS. As side effect, temporary dysarthria occurred in one patient. Dysarthria alleviated after changing the stimulation parameters.
Conclusion: This case series emphasize that horizontal steering of the electrical field by applying directional stimulation can be used both to attenuate inadvertent spreading of the electrical current causing side-effects and to improve the clinical benefit of DBS in treating dystonia.
References
- 1.
- Hu W, Stead M. Deep brain stimulation for dystonia. Transl Neurodegener. 2014;3(1):2.
- 2.
- Masuda H, Shirozu H, Ito Y, Fukuda M, Fujii Y. Surgical Strategy for Directional Deep Brain Stimulation. Neurol Med Chir (Tokyo). 2022 Jan 15;62(1):1-12.
- 3.
- Abel M, Pfister R, Hussein I, Alsalloum F, Onyinzo C, Kappl S, et al. Deep Brain Stimulation in KMT2B-Related Dystonia: Case Report and Review of the Literature With Special Emphasis on Dysarthria and Speech. Front Neurol. 2021;12:662910.
