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Klinische Neurophysiologie 2014; 45(02): 100-105
DOI: 10.1055/s-0034-1372631
Originalia
© Georg Thieme Verlag KG Stuttgart · New York

Tiefe Hirnstimulation bei sekundären Dystonien im Kindesalter

Deep Brain Stimulation in Secondary Dystonia in Childhood
A. Koy
1   Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
2   Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Zentrum für Kinder- und Jugendmedizin, ­Universitätsklinikum Düsseldorf, Düsseldorf
,
L. Timmermann
1   Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
,
K. A. M. Pauls
1   Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
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Publikationsdatum:
01. Juli 2014 (online)

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Zusammenfassung

Sekundäre Dystonien im Kindesalter umfassen eine heterogene Krankheitsgruppe mit unterschiedlichen Ätiologien. Die dyskinetische Ze­rebralparese ist die häufigste Ursache. Pharmakotherapie ist oftmals ohne Effekt oder die Nebenwirkungen werden nicht toleriert. In den letzten Jahren haben einige Patienten mit sekundärer Dystonie eine Tiefe Hirnstimulation (THS) erhalten. Die Ergebnisse sind sehr unterschiedlich und reichen von sehr gutem Ansprechen bis hin zu keinem Effekt. Patienten, die sich anhand klinischer Dystonie-Skalen kaum verbessern, berichten oftmals von einer Verbesserung der Lebensqualität. Es gibt wenige Daten zur Anwendung im Kindesalter. Die Erfahrungen zur THS bei Patienten mir primärer oder idiopathischer Dystonie weisen darauf hin, dass die THS zu einem frühen Zeitpunkt des Krankheitsverlaufs oftmals mit einem größeren Effekt assoziiert ist. Dennoch ist die Indikation zur THS im Kindesalter sorgfältig abzuwägen. Für die Zukunft sind größere prospektive Studien mit jungen, gut charakterisierten, homogenen Patientenkohorten erforderlich, die den Effekt der THS auf Bereiche wie Motorik und Lebensqualität systematisch erfassen, um die Bedeutung der THS als Therapieoption für Patienten mit sekundärer Dystonie weiter zu evaluieren.

Abstract

Secondary dystonia encompasses a heterogeneous group of diseases with different aetiologies. Cerebral palsy is the most common cause. Pharmacological treatment is often unsatisfactory or side effects are not well tolerated. During the last decade some patients with secondary dystonia were treated with deep brain stimulation (DBS) – with varying results ranging from a good response to no effect. Patients without measurable response in clinical rating scales for dystonia sometimes report improvements in quality of life. The data on paediatric DBS are very limited. According to the experiences with DBS in patients with primary or idiopathic dystonia, DBS at an early stage of disease progression is associated with a greater improvement. Still, the indication for DBS in children has to be considered carefully. In the future, larger prospective studies with young, well-characterised and aetiologically homogeneous cohorts of patients with secondary dystonia are necessary to systematically investigate the effect of DBS on motor function and quality of life to further evaluate the role of DBS in secondary dystonia.

Schlüsselwörter

kindliche Bewegungsstörungen - sekundäre Dystonie - Tiefe Hirnstimulation

Key words

paediatric movement disorders - secondary dystonia - deep brain stimulation
 

  • Literatur

  • 1 Sanger TD, Chen D, Fehlings DL et al. Definition and classification of hyperkinetic movements in childhood. Mov Disord 2010; 25: 1538-1549
    CrossrefPubMedSuche in Google Scholar
  • 2 Albanese A, Bhatia K, Bressman SB et al. Phenomenology and classification of dystonia: a consensus update. Mov Disord 2013; 28: 863-873
    CrossrefPubMedSuche in Google Scholar
  • 3 Singer HS, Mink JW, Gilbert DL et al. Movement Disorders in Childhood. Philadelphia: Saunders Elsevier; 2010. Chapter 17, 222-223
    Suche in Google Scholar
  • 4 Surveillance of cerebral palsy in Europe (SCPE) . Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Dev Med Child Neurol 2000; 42: 816-824
    PubMedSuche in Google Scholar
  • 5 Bax M, Goldstein M, Rosenbaum P et al. Proposed definition and classification of cerebral palsy. Dev Med Child Neurol 2005; 47: 571-576
    CrossrefPubMedSuche in Google Scholar
  • 6 Keogh JM, Badawi N. The origins of cerebral palsy. Curr Opinion Neurol 2006; 19: 129-134
    CrossrefPubMedSuche in Google Scholar
  • 7 Treves T, Korczyn AD. Progressive dystonia and paraparesis in cerebral palsy. Eur Neurol 1986; 25: 148-153
    CrossrefPubMedSuche in Google Scholar
  • 8 Jankovic J. Medical treatment of dystonia. Mov Disord 2013; 28: 1001-1012
    CrossrefPubMedSuche in Google Scholar
  • 9 Cooper IS. 20-year follow-up study of the neurosurgical treatment of dystonia musculorum deformans. Adv Neurol 1976; 14: 423-452
    PubMedSuche in Google Scholar
  • 10 Iacono RP, Kuniyoshi SM, Lonser RR et al. Simultaneous bilateral pallidoansotomy for idiopathic dystonia musculorum deformans. Pediatr Neurol 1996; 14: 145-148
    CrossrefPubMedSuche in Google Scholar
  • 11 Ondo WG, Desaloms JM, Jankovic J et al. Pallidotomy for generalized dystonia. Mov Disord 1998; 13: 693-698
    CrossrefPubMedSuche in Google Scholar
  • 12 Coubes P, Cif L, El Fertit H et al. Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: long-term results. J Neurosurg 2004; 101: 189-194
    CrossrefPubMedSuche in Google Scholar
  • 13 Vidailhet M, Vercueil L, Houeto JL et al. French Stimulation du Pallidum Interne dans la Dystonie (SPIDY) Study Group. Bilateral deep-brain stimulation of the globus pallidus in primary generalized dystonia. N Engl J Med 2005; 352: 459-467
    CrossrefPubMedSuche in Google Scholar
  • 14 Kupsch A, Benecke R, Muller J et al. Deep-Brain Stimulation for Dystonia Study Group, 2006. Pallidal deep-brain stimulation in primary generalized or segmental dystonia. N Engl J Med 2006; 355: 1978-1990
    CrossrefPubMedSuche in Google Scholar
  • 15 Vidailhet M, Vercueil L, Houeto JL et al. French SPIDY Study Group . Bilateral, pallidal, deep-brain stimulation in primary generalised dystonia: a prospective 3 year follow-up study. Lancet Neurol 2007; 6: 223-229
    CrossrefPubMedSuche in Google Scholar
  • 16 Cif L, Vasques X, Gonzalez V et al. Long-term follow-up of DYT1 dystonia patients treated by deep brain stimulation: an open-label study. Mov Disord 2010; 25: 289-299
    CrossrefPubMedSuche in Google Scholar
  • 17 Halbig TD, Gruber D, Kopp UA et al. Pallidal stimulation in dystonia: effects on cognition, mood, and quality of life. J Neurol Neurosurg Psychiatry 2005; 76: 1713-1716
    CrossrefPubMedSuche in Google Scholar
  • 18 Markun LC, Starr PA, Air EL et al. Shorter disease duration correlates with improved long-term deep brain stimulation outcomes in young-onset DYT1 dystonia. Neurosurgery 2012; 71: 325-330
    CrossrefPubMedSuche in Google Scholar
  • 19 Andrews C, Aviles-Olmos I, Hariz M et al. Which patients with dystonia benefit from deep brain stimulation? A metaregression of individual patient outcomes. J Neurol Neurosurg Prychiatry 2010; 81: 1383-1389
    PubMedSuche in Google Scholar
  • 20 Holloway KL, Baron MS, Brown R et al. Deep brain stimulation for dystonia: a meta-analysis. Neuromodulation 2006; 9: 253-261
    CrossrefPubMedSuche in Google Scholar
  • 21 Isaias IO, Alterman RL, Tagliati M. Outcome predictors of pallidal stimulation in patients with primary dystonia: the role of disease duration. Brain 2008; 131: 1895-1902
    CrossrefPubMedSuche in Google Scholar
  • 22 Marks WA, Honeycutt J, Acosta Jr F et al. Dystonia due to cerebral palsy responds to deep brain stimulation of the globus pallidus internus. Mov Disord 2011; 26: 1748-1751
    CrossrefPubMedSuche in Google Scholar
  • 23 Air EL, Ostrem JL, Sanger TD et al. Deep brain stimulation in children: experience and technical pearls. J Neurosurg Pediatr 2011; 8: 565-574
    CrossrefPubMedSuche in Google Scholar
  • 24 Borggraefe I, Mehrkens JH, Telegravciska M et al. Bilateral pallidal stimulation in children and adolescents with primary generalized dystonia: report of six patients and literature-based analysis of predictive outcomes variables. Brain Dev 2010; 32: 223-228
    CrossrefPubMedSuche in Google Scholar
  • 25 Cif L, Biolsi B, Gavarini S et al. Antero-ventral internal pallidum stimulation improves behavioral disorders in Lesch-Nyhan disease. Mov Disord 2007; 22: 2126-2129
    CrossrefPubMedSuche in Google Scholar
  • 26 Koy A, Hellmich M, Pauls KA et al. Effects of deep brain stimulation in dyskinetic cerebral palsy: A meta-analysis. Mov Disord 2013; 28: 647-654
    CrossrefPubMedSuche in Google Scholar
  • 27 Vayssiere N, Hemm S, Zanca M et al. Comparison of atlas- and magnetic resonances imaging-based stereotactic targeting of the globus pallidus internus in the performance of deep brain stimulation for treatment of dystonia. J Neurosurg 2002; 96: 673-679
    CrossrefPubMedSuche in Google Scholar
  • 28 Alterman RL, Tagliati M. Pallidal stimulation improves pantothenate kinase-associated neurodegeneration. Childs Nerv Syst 2007; 23: 1033-1040
    CrossrefPubMedSuche in Google Scholar
  • 29 Olaya JE, Christian E, Ferman D. Deep brain stimulation in children and young adults with secondary dystonia: the Children’s Hospital Los Angeles experience. Neurosurg Focus 2013; 35: E7
    PubMedSuche in Google Scholar
  • 30 Castelnau P, Cif L, Valente EM et al. Pallidal stimulation improves pantothenate kinase-associated neurodegeneration. Ann Neurol 2005; 57: 738-741
    CrossrefPubMedSuche in Google Scholar
  • 31 Timmermann L, Pauls KA, Wieland K et al. Dystonia in neurodegeneration with brain iron accumulation: outcome of bilateral pallidal stimulation. Brain 2010; 133: 701-712
    CrossrefPubMedSuche in Google Scholar
  • 32 Gimeno H, Tustin K, Selway R et al. Beyond the Burke-Fahn-Marsden Dystonia Rating Scale: Deep brain stimulation in childhood secondary dystonia. Eur J of Paediatr Neurol 2012;
    PubMedSuche in Google Scholar
  • 33 Eltahawy HA, Saint-Cyr J, Giladi N et al. Primary dystonia is more responsive than secondary dystonia to pallidal interventions: outcome after pallidotomy or pallidal deep brain stimulation. Neurosurgery 2004; 54: 613-619
    CrossrefPubMedSuche in Google Scholar
  • 34 Lipsman N, Ellis M, Lozano AM. Current and future indications for deep brain stimulation in pediatric populations. Neurosurg Focus 2010; 29: E2
    PubMedSuche in Google Scholar
  • 35 Hebb MO, Gaudet P, Mendez I. Deep brain stimulation to treat hyperkinetic symptoms of Cockayne syndrome. Mov Disord 2006; 21: 112-115
    CrossrefPubMedSuche in Google Scholar
  • 36 Monbaliu E, Ortibus E, De Cat J et al. The Dyskinesia Impairment Scale: a new instrument to measure dystonia and choreoathetosis in dyskinetic cerebral palsy. Dev Med Child Neurol 2012; 54: 278-283
    CrossrefPubMedSuche in Google Scholar
  • 37 Monbaliu E, Ortibus E, Roelens F et al. Rating scales for dystonia in cerebral palsy: reliability and validity. Dev Med Child Neurol 2010; 52: 570-575
    CrossrefPubMedSuche in Google Scholar
  • 38 Vidailhet M, Yelnik J, Lagrange C et al. French SPIDY-2 Study Group . Bilateral pallidal deep brain stimulation for the treatment of patients with dystonia-choreoathetosis cerebral palsy: a prospective pilot study. Lancet Neurol 2009; 8: 709-717
    CrossrefPubMedSuche in Google Scholar
  • 39 Lundy C, Lumsden D, Fairhurst C. Treating complex movement disorders in children with cerebral palsy. Ulster Med J 2009; 78: 157-163
    PubMedSuche in Google Scholar
  • 40 Krauss JK, Loher TJ, Weigel R et al. Chronic stimulation of the globus pallidus internus for treatment of non-DYT1 generalized dystonia and choreoathetosis: 2-year follow up. J Neurosurg 2003; 98: 785-792
    CrossrefPubMedSuche in Google Scholar
  • 41 Tronnier VM, Fogel W. Pallidal stimulation for generalized dystonia. Report of three cases. J Neurosurg 2000; 92: 453-456
    CrossrefPubMedSuche in Google Scholar
  • 42 Cif L, El Fertit H, Vayssiere N et al. Treatment of dystonic syndromes by chronic electrical stimulation of the internal globus pallidus. J Neurosurg Sci 2003; 47: 52-55
    PubMedSuche in Google Scholar
  • 43 Lumsden DE, Kaminska M, Gimeno H et al. Proportion of life lived with dystonia inversely correlates with response to pallidal deep brain stimulation in both primary and secondary childhood dystonia. Dev Med Child Neurol 2013; 55: 567-574
    CrossrefPubMedSuche in Google Scholar
  • 44 Volkmann J, Wolters A, Kupsch A et al. Pallidal deep brain stimulation in patients with primary generalised or segmental dystonia: 5-year follow-up of a randomised trial. Lancet Neurol 2012; 11: 1029-1038
    CrossrefPubMedSuche in Google Scholar
  • 45 Pillon B, Ardouin C, Dujardin K et al. Preservation of cognitive function in dystonia treated by pallidal stimulation; French SPIDY Study Group. Neurology 2006; 66: 1556-1558
    CrossrefPubMedSuche in Google Scholar
  • 46 Voges J, Hilker R, Botzel K et al. Thirty days complication rate following surgery performed for deep-brain-stimulation. Mov Disord 2007; 22: 1486-1489
    CrossrefPubMedSuche in Google Scholar
  • 47 Kaminska M, Lumsden DE, Ashkan K et al. Rechargeable deep brain stimulators in the management of paediatric dystonia: well tolerated with a low complication rate. Stereotact Funct Neurosurg 2012; 90: 233-239
    CrossrefPubMedSuche in Google Scholar