Rechargeable deep brain stimulators in the management of paediatric dystonia: well tolerated with a low complication rate.
BACKGROUND
Deep brain stimulation (DBS) is a recognised method of treatment for primary and secondary dystonia. The size of non-rechargeable batteries has limited their use in small children. Our severe dystonia patients have required battery replacement every 20-24 months.


OBJECTIVE
To evaluate reliability, care burden, patients' satisfaction and complications related to the rechargeable neurostimulator Activa® RC (launched by Medtronic in Europe in autumn 2008).


METHODS
Complications were recorded prospectively, and a questionnaire on neurostimulator maintenance, care burden and parental satisfaction was applied to all patients with at least 3 months of follow-up.


RESULTS
30 Activa RCs were implanted between December 2008 and June 2010, 25 with a follow-up of 3-17 months (mean 10); the mean patient's age at surgery was 11.1 years; 22/25 questionnaires were completed. All families achieved good standards of recharging. Caregivers were responsible for recharging in 82% of cases. With higher parameters of stimulation, recharging time was longer than initially recommended by the manufacturer. All but one family would recommend Activa RC to other patients. Transient recharging problems were the most common complication (36% of cases). Infection/skin erosion occurred in 8% of cases, self-resolving early seroma in 20%.


CONCLUSIONS
Activa was found to offer reliable stimulation with a low rate of significant complications and a suitable treatment option for children with dystonia.
Complex Motor Disorder Service, Evelina Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK. margaret.kaminska@gstt.nhs.uk
Margaret
M
Kaminska
Daniel E
DE
Lumsden
Keyoumars
K
Ashkan
Irfan
I
Malik
Richard
R
Selway
Jean-Pierre
JP
Lin
D000293:Adolescent; D001921:Brain; D002648:Child; D002675:Child, Preschool; D046690:Deep Brain Stimulation; D004421:Dystonia / Q000628:therapy*; D020821:Dystonic Disorders / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058542:Implantable Neurostimulators; D008297:Male; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult