A Koy1, N Bockhorn2, A A Kühn3, G-H Schneider4, P Krause3, K Lauritsch3, K Witt5, S Paschen6, G Deuschl6, J K Krauss7, A Saryyeva7, J Runge7, I Borggraefe8, J H Mehrkens9, A Horn10, J Vesper11, A Schnitzler12, S Siegert13, M Freilinger13, M Eckenweiler14, V A Coenen15, V Tadic16, J Voges17, K A M Pauls18, J Wirths19, L Timmermann20, M Hellmich21. 1. Department of Pediatrics, University Hospital of Cologne, Germany. Electronic address: anne.koy@uk-koeln.de. 2. Department of Pediatrics, University Hospital of Cologne, Germany. 3. Department of Neurology, Charité University Medicine, Berlin, Germany. 4. Department of Neurosurgery, Charité University Medicine, Berlin, Germany. 5. Deptartment of Neurology, Evangelic Hospital Oldenburg, Carl von Ossietzky University, Oldenburg, Germany; Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany. 6. Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany. 7. Department of Neurosurgery, Medical School, MHH, Hanover, Germany. 8. Department of Pediatrics, Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Comprehensive Epilepsy Center, University Hospital, Ludwig Maximilians University of Munich, Germany. 9. Department of Neurosurgery, University Hospital, Ludwig Maximilians University of Munich, Germany. 10. Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Medical Faculty, Heinrich-Heine University, Dusseldorf, Germany. 11. Department of Functional Neurosurgery and Stereotaxy, Medical Faculty, Heinrich-Heine University, Dusseldorf, Germany. 12. Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Dusseldorf, Germany. 13. Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Austria. 14. Department of Neuropediatrics and Muscle Disorders, University Medical Center, Faculty of Medicine, University of Freiburg, Germany. 15. Department of Stereotactic and Functional Neurosurgery, University Medical Center and Faculty of Medicine, Freiburg University, Freiburg i.Br., Germany. 16. Department of Neurology, University Hospital of Lubeck, Germany. 17. Department of Stereotactic Neurosurgery, University Hospital Magdeburg, Germany; Leibniz-Institute for Neurobiology, Magdeburg, Germany. 18. Department of Neurology, University Hospital of Cologne, Germany. 19. Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Germany. 20. Department of Neurology, University Hospital of Cologne, Germany; Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Germany. 21. Institute of Medical Statistics and Computational Biology, University of Cologne, Germany.
Abstract
BACKGROUND: Data on pediatric DBS is still limited because of small numbers in single center series and lack of systematic multi-center trials. OBJECTIVES: We evaluate short- and long-term adverse events (AEs) of patients undergoing deep brain stimulation (DBS) during childhood and adolescence. METHODS: Data collected by the German registry on pediatric DBS (GEPESTIM) were analyzed according to reversible and irreversible AEs and time of occurrence with relation to DBS-surgery: Intraoperative, perioperative (<4 weeks), postoperative (4 weeks < 6 months) and long term AEs (>6 months). RESULTS: 72 patients with childhood-onset dystonia from 10 DBS-centers, who received 173 DBS electrodes and 141 implantable pulse generators (IPG), were included in the registry. Mean time of postoperative follow-up was 4.6 ± 4 years. In total, 184 AEs were documented in 53 patients (73.6%). 52 DBS-related AEs in 26 patients (36.1%) required 45 subsequent surgical interventions 4.7 ± 4.1 years (range 3 months-15 years) after initial implantation. The total risk of an AE requiring surgical intervention was 7.9% per electrode-year. Hardware-related AEs were the most common reason for surgery. There was a tendency of a higher rate of AEs in patients aged 7-9 years beyond 6 months after implantation. DISCUSSION: The intraoperative risk of AEs in pediatric patients with dystonia undergoing DBS is very low, whereas the rate of postoperative hardware-related AEs is a prominent feature with a higher occurrence compared to adults, especially on long-term follow-up. CONCLUSION: Factors leading to such AEs must be identified and patient management has to be focused on risk minimization strategies in order to improve DBS therapy and maximize outcome in pediatric patients.
BACKGROUND: Data on pediatric DBS is still limited because of small numbers in single center series and lack of systematic multi-center trials. OBJECTIVES: We evaluate short- and long-term adverse events (AEs) of patients undergoing deep brain stimulation (DBS) during childhood and adolescence. METHODS: Data collected by the German registry on pediatric DBS (GEPESTIM) were analyzed according to reversible and irreversible AEs and time of occurrence with relation to DBS-surgery: Intraoperative, perioperative (<4 weeks), postoperative (4 weeks < 6 months) and long term AEs (>6 months). RESULTS: 72 patients with childhood-onset dystonia from 10 DBS-centers, who received 173 DBS electrodes and 141 implantable pulse generators (IPG), were included in the registry. Mean time of postoperative follow-up was 4.6 ± 4 years. In total, 184 AEs were documented in 53 patients (73.6%). 52 DBS-related AEs in 26 patients (36.1%) required 45 subsequent surgical interventions 4.7 ± 4.1 years (range 3 months-15 years) after initial implantation. The total risk of an AE requiring surgical intervention was 7.9% per electrode-year. Hardware-related AEs were the most common reason for surgery. There was a tendency of a higher rate of AEs in patients aged 7-9 years beyond 6 months after implantation. DISCUSSION: The intraoperative risk of AEs in pediatric patients with dystonia undergoing DBS is very low, whereas the rate of postoperative hardware-related AEs is a prominent feature with a higher occurrence compared to adults, especially on long-term follow-up. CONCLUSION: Factors leading to such AEs must be identified and patient management has to be focused on risk minimization strategies in order to improve DBS therapy and maximize outcome in pediatric patients.
Authors: Katrina A MuÑoz; Jennifer Blumenthal-Barby; Eric A Storch; Laura Torgerson; Gabriel LÁzaro-MuÑoz Journal: Camb Q Healthc Ethics Date: 2020-10 Impact factor: 1.566
Authors: Liesanne M Centen; D L Marinus Oterdoom; Marina A J Tijssen; Ivon Lesman-Leegte; Martje E van Egmond; J Marc C van Dijk Journal: Mov Disord Date: 2020-11-20 Impact factor: 10.338