Division of Neurology, Department of Pediatrics, Children's Mercy Hospital, 12273University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital & University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.
J Child Neurol. 2022 Oct;37(10-11):813-824. doi: 10.1177/08830738221115248. Epub 2022 Sep 2.
Deep brain stimulation (DBS) is an established intervention for use in pediatric movement disorders, especially dystonia. Although multiple publications have provided guidelines for deep brain stimulation patient selection and programming in adults, there are no evidence-based or consensus statements published for pediatrics. The result is lack of standardized care and underutilization of this effective treatment. To this end, we assembled a focus group of 13 pediatric movement disorder specialists and 1 neurosurgeon experienced in pediatric deep brain stimulation to review recent literature and current practices and propose a standardized approach to candidate selection, implantation target site selection, and programming algorithms. For pediatric dystonia, we provide algorithms for (1) programming for initial session and follow-up sessions, and (2) troubleshooting side effects encountered during programming. We discuss common side effects, how they present, and recommendations for management. This topical review serves as a resource for movement disorders specialists interested in using deep brain stimulation for pediatric dystonia.
脑深部电刺激（DBS）是一种成熟的干预手段，用于治疗儿科运动障碍，尤其是肌张力障碍。尽管已有多篇出版物为成人提供了 DBS 患者选择和程控的指南，但尚未为儿科患者发布基于证据的共识声明。其结果是缺乏标准化的护理，且这种有效的治疗方法未得到充分利用。为此，我们召集了一个由 13 名儿科运动障碍专家和 1 名对儿童脑深部电刺激有经验的神经外科医生组成的焦点小组，以回顾最新文献和当前实践，并提出一种标准化的候选者选择、植入靶点选择和编程算法的方法。对于儿科肌张力障碍，我们提供了（1）初始治疗和随访治疗的编程算法，以及（2）编程过程中遇到的副作用问题的处理方法。我们讨论了常见的副作用，它们的表现以及处理建议。本专题综述为有兴趣使用脑深部电刺激治疗儿科肌张力障碍的运动障碍专家提供了一个资源。
