Deep brain stimulation for cerebral palsy: where are we now?

Abstract

DBS Deep brain stimulation GPiInternal globus pallidusCerebral palsy (CP) is a complex disorder and children frequently have multiple impairments. Dystonia is a particularly frustrating impairment that interferes with rehabilitation and function and is difficult to treat. Of the available treatments, deep brain stimulation (DBS) has emerged as an option with the potential for large effect size in a subgroup of children. While brain stimulation has been used in CP for more than 40 years, modern devices and targeting methods are improving both the safety and efficacy of the procedure. Successful use of DBS depends on appropriate selection of patients, identification of effective neuroanatomical targets in each patient, careful neurosurgical procedure, and detailed follow-up evaluation and programming. The use of functional neurosurgery for neuromodulation in CP remains a technology in its infancy, but improving experience and knowledge are likely to make this one of the safest and most effective interventions for children with moderate-to-severe motor disorders. This review summarizes the current procedures for patient and target selection, and surgical implantation of DBS electrodes for CP. The history of DBS and future directions when used in secondary dystonia are also examined.

Neuromodulation for children with cerebral palsy

“…3 Overall, DBS seems to be less effective and with more variable outcomes in dyskinetic CP compared to isolated, idiopathic, or monogenetic dystonia. Dyskinetic CP is the most frequent cause of acquired dystonia in childhood, leading to severe physical disability.…”

“…Dyskinetic CP is the most frequent cause of acquired dystonia in childhood, leading to severe physical disability. 3 Furthermore, it can be challenging to assess positive motor outcomes in patients with associated severe spasticity, ataxia, and fixed skeletal deformities. In isolated dystonia, surgical treatment with deep brain stimulation (DBS) of the globus pallidus internus has emerged as a very effective strategy, 1 but its benefits for dyskinetic CP are still debated.…”

“…In isolated dystonia, surgical treatment with deep brain stimulation (DBS) of the globus pallidus internus has emerged as a very effective strategy, 1 but its benefits for dyskinetic CP are still debated. 3 Furthermore, it can be challenging to assess positive motor outcomes in patients with associated severe spasticity, ataxia, and fixed skeletal deformities. 3 Overall, DBS seems to be less effective and with more variable outcomes in dyskinetic CP compared to isolated, idiopathic, or monogenetic dystonia.…”

“…In isolated dystonia, surgical treatment with deep brain stimulation (DBS) of the globus pallidus internus has emerged as a very effective strategy, but its benefits for dyskinetic CP are still debated . In this timely review by Sanger, the state of the art of DBS for dyskinetic CP is nicely and concisely described …”

“…This unsolved issue also impacts the choice of possible better targets for DBS therapy, especially considering the frequent presence of structural brain lesions. Indeed, there is some evidence suggesting that other targets besides the globus pallidus internus can be a better choice in CP . Furthermore, it can be challenging to assess positive motor outcomes in patients with associated severe spasticity, ataxia, and fixed skeletal deformities.…”