title: Considerations in deep brain stimulation (DBS) for pediatric secondary dystonia.
abstract: OBJECTIVE
  There is a paucity of effective long-term medication treatment for secondary dystonias. In situations where significantly impairing secondary dystonias fail to respond to typical enteral medications and intrathecal (or even intraventricular) baclofen, consideration should be given to the use of deep brain stimulation (DBS). While Level I evidence and long-term follow-up clearly demonstrate the efficacy of DBS for primary dystonia, the evidence for secondary dystonia remains mixed and unclear. In this study, we report our experience with pediatric subjects who have undergone DBS for secondary dystonia.
  
  
  METHODS
  We discuss the indications and outcomes of DBS procedures completed at our center. We also present a detailed discussion of the considerations in the management of these patients as well as a literature review.
  
  
  RESULTS
  Of the four cases retrospectively examined here, all subjects experienced reductions in the severity of their dystonia (ranging from 0 to 100% on both the Barry-Albright Dystonia (BAD) and Burke-Fahn-Marsden Dystonia Rating Scale-Motor (BFMDRS-M) scales).
  
  
  CONCLUSIONS
  Pallidal DBS should be considered among children with functionally debilitating, medication-resistant secondary dystonia. Patients without fixed skeletal deformities who have experienced a short duration of symptoms are most likely to benefit from this intervention.
authors.affiliation: Division of Neurosurgery, Children's National Health System, 4th Floor, Suite 100, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
authors.forename: Deki
authors.initials: D
authors.lastname: Tsering
authors.affiliation: Division of Neurology, Children's National Health System, Washington, DC, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Tochen
authors.affiliation: Division of Neurology, Children's National Health System, Washington, DC, USA.|The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
authors.forename: Bennett
authors.initials: B
authors.lastname: Lavenstein
authors.affiliation: The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.|Division of Anesthesiology, Children's National Health System, Washington, DC, USA.
authors.forename: Srijaya K
authors.initials: SK
authors.lastname: Reddy
authors.affiliation: Division of Neuropsychology, Children's National Health System, Washington, DC, USA.
authors.forename: Yael
authors.initials: Y
authors.lastname: Granader
authors.affiliation: Division of Neurosurgery, Children's National Health System, 4th Floor, Suite 100, 111 Michigan Avenue NW, Washington, DC, 20010, USA.|The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Keating
authors.affiliation: Division of Neurosurgery, Children's National Health System, 4th Floor, Suite 100, 111 Michigan Avenue NW, Washington, DC, 20010, USA. coluigbo@childrensnational.org.|The George Washington University School of Medicine and Health Sciences, Washington, DC, USA. coluigbo@childrensnational.org.
authors.forename: Chima O
authors.initials: CO
authors.lastname: Oluigbo
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D046690:Deep Brain Stimulation / Q000379:methods*; D020821:Dystonic Disorders / Q000145:classification / Q000628:therapy*; D005260:Female; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Deep brain stimulation; Pediatric neurosurgery; Secondary dystonia