title: Deep brain stimulation for childhood dystonia: Is 'where' as important as in 'whom'?
abstract: Deep brain stimulation (DBS) has become a mainstay of dystonia management in adulthood. Typically targeting electrode placement in the GPi, sustained improvement in dystonic symptoms are anticipated in adults with isolated genetic dystonias. Dystonia in childhood is more commonly a symptomatic condition, with dystonia frequently expressed on the background of a structurally abnormal brain. Outcomes following DBS in this setting are much more variable, the reasons for which have yet to be elucidated. Much of the focus on improving outcomes following DBS in dystonia management has been on the importance of patient selection, with, until recently, little discussion of the choice of target. In this review, we advance the argument that patient selection for DBS in childhood cannot be made separate from the choice of target nuclei. The anatomy of common DBS targets is considered, and factors influencing their choice for electrode insertion are discussed. We propose an "ABC" for DBS in childhood dystonia is proposed: Appropriate Child selected; Best nuclei chosen for electrode insertion; Correct position within that nucleus.
authors.affiliation: Complex Motor Disorder Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK. Electronic address: Daniel.lumsden@gstt.nhs.uk.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Lumsden
authors.affiliation: Complex Motor Disorder Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Kaminska
authors.affiliation: Functional Neurosurgery, Department of Neurosurgery, Clinical Neurosciences, King's College Hospital, London, UK.
authors.forename: Keyoumars
authors.initials: K
authors.lastname: Ashkan
authors.affiliation: Functional Neurosurgery, Department of Neurosurgery, Clinical Neurosciences, King's College Hospital, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Selway
authors.affiliation: Complex Motor Disorder Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lin
mesh_terms: D001921:Brain / Q000033:anatomy & histology*; D002648:Child; D046690:Deep Brain Stimulation; D020821:Dystonic Disorders / Q000000981:diagnostic imaging / Q000628:therapy*; D005917:Globus Pallidus / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D018579:Patient Selection
keywords: Basal ganglia; Childhood; Deep brain stimulation; Dystonia; Electrode