Pediatric Deep Brain Stimulation Using Awake Recording and Stimulation for Target Selection in an Inpatient Neuromodulation Monitoring Unit

Terence D Sanger; Mark Liker; Enrique Arguelles; Ruta Deshpande; Arash Maskooki; Diana Ferman; Aprille Tongol; Aaron Robison

doi:10.3390/brainsci8070135

Pediatric Deep Brain Stimulation Using Awake Recording and Stimulation for Target Selection in an Inpatient Neuromodulation Monitoring Unit

Brain Sci. 2018 Jul 17;8(7):135. doi: 10.3390/brainsci8070135.

Authors

Terence D Sanger^{1

2}, Mark Liker³, Enrique Arguelles⁴, Ruta Deshpande⁵, Arash Maskooki⁶, Diana Ferman^{7

8}, Aprille Tongol⁹, Aaron Robison¹⁰

Affiliations

¹ Department of Neurology, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. terry@sangerlab.net.
² Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089-1111, USA. terry@sangerlab.net.
³ Department of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. liker@usc.edu.
⁴ Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089-1111, USA. enrique.arguelles@usc.edu.
⁵ Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089-1111, USA. rutadesh@usc.edu.
⁶ Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089-1111, USA. maskooki@usc.edu.
⁷ Department of Neurology, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. dferman@usc.edu.
⁸ Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089-1111, USA. dferman@usc.edu.
⁹ Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089-1111, USA. tongol@usc.edu.
¹⁰ Department of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. arobison@chla.usc.edu.

Abstract

Deep brain stimulation (DBS) for secondary (acquired, combined) dystonia does not reach the high degree of efficacy achieved in primary (genetic, isolated) dystonia. We hypothesize that this may be due to variability in the underlying injury, so that different children may require placement of electrodes in different regions of basal ganglia and thalamus. We describe a new targeting procedure in which temporary depth electrodes are placed at multiple possible targets in basal ganglia and thalamus, and probing for efficacy is performed using test stimulation and recording while children remain for one week in an inpatient Neuromodulation Monitoring Unit (NMU). Nine Children with severe secondary dystonia underwent the NMU targeting procedure. In all cases, 4 electrodes were implanted. We compared the results to 6 children who had previously had 4 electrodes implanted using standard intraoperative microelectrode targeting techniques. Results showed a significant benefit, with 80% of children with NMU targeting achieving greater than 5-point improvement on the Burke⁻Fahn⁻Marsden Dystonia Rating Scale (BFMDRS), compared with 50% of children using intraoperative targeting. NMU targeting improved BFMDRS by an average of 17.1 whereas intraoperative targeting improved by an average of 10.3. These preliminary results support the use of test stimulation and recording in a Neuromodulation Monitoring Unit (NMU) as a new technique with the potential to improve outcomes following DBS in children with secondary (acquired) dystonia. A larger sample size will be needed to confirm these results.

Keywords: deep brain stimulation; pediatric; secondary dystonia; stereo EEG; targeting.