Long‐Term Follow‐Up of Pediatric Patients with Dyskinetic Cerebral Palsy and Deep Brain Stimulation

Abstract

BackgroundDeep brain stimulation (DBS) has been increasingly used in the management of dyskinetic cerebral palsy (DCP). Data on long‐term effects and the safety profile are rare.ObjectivesWe assessed the efficacy and safety of pallidal DBS in pediatric patients with DCP.MethodsThe STIM‐CP trial was a prospective, single‐arm, multicenter study in which patients from the parental trial agreed to be followed‐up for up to 36 months. Assessments included motor and non‐motor domains.ResultsOf the 16 patients included initially, 14 (mean inclusion age 14 years) were assessed. There was a significant change in the (blinded) ratings of the total Dyskinesia Impairment Scale at 36 months. Twelve serious adverse events (possibly) related to treatment were documented.ConclusionDBS significantly improved dyskinesia, but other outcome parameters did not change significantly. Investigations of larger homogeneous cohorts are needed to further ascertain the impact of DBS and guide treatment decisions in DCP. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

A retrospective, naturalistic study of deep brain stimulation and vagal nerve stimulation in young patients*

“…We did not observe any differences in surgical complications between the two groups. Although the rate of complication was high compared to safety reviews for DBS and VNS procedures (Koy et al., 2023 ; Revesz et al., 2016 ), it is possible that including all physical complications after the procedure increased the rate of overall complications reported in our study.…”

Motor network dynamic resting state fMRI connectivity of neurotypical children in regions affected by cerebral palsy

“…Medication-based therapy for cerebral palsy (CP), which impacts 1.5 to 2.5 per 1,000 live births, is often unsatisfactory ( Elia et al, 2018 ). One promising solution for those with symptoms of athetosis, chorea or dystonia, which are found in many subtypes of CP, is deep brain stimulation (DBS), which is limited by lack of precision-based models to direct the DBS lead placement with less than 50–75% success, and frequent complications ( Elia et al, 2018 ; Koy et al, 2023 ). Comparatively, in diseases such as Parkinson’s disease, DBS lead placement informed by rs-fMRI analysis of the motor networks (MN) , has improved outcomes ( Horn et al, 2017 ).…”

“…Hence the primary aim of this study was to create a prototypical resting-state MN EC model in typically developing young children, for later comparison of the same study in children with CP, encompassing cortical and subcortical MN circuitry, which are the primary regions impacted in cerebral palsy ( Kelly et al, 2015 ; Lazzari et al, 2015 ; Elia et al, 2018 ; Wolf et al, 2019 ; Sadowska et al, 2020 ; Koy et al, 2023 ). Thus, the study sought to: (1) identify the effective dynamics of the MN circuitry in children at rest—i.e., while not initiating, stopping, or ‘tuning’ a motor action—and not time-locked to movement events (e.g., tremors), and (2) evaluate these connections for association with age and motor skill.…”