Deep Brain Stimulation For Dystonia Due To Cerebral Palsy

Deep Brain Stimulation For Dystonia Due To Cerebral Palsy

The term “cerebral palsy” (CP) refers to a diverse range of syndromes that result in an early-onset, non-progressive condition with impaired movement and posture control. Different aetiologies might contribute to the clinical spectrum of CP, but they are all characterized by a disturbance of motor control. Based on the motor disability, there are four main forms of CP: mainly spastic, dyskinetic, ataxic, and mixed form. In children, acquired dystonia is most frequently caused by dyskinetic CP (DCP). Due to the fact that most DCP sufferers have varying degrees of chorea, athetosis, and dystonia, treatment can be difficult. Treatment with pharmaceuticals is frequently ineffective. Functional neurosurgery, particularly deep brain stimulation that targets the cerebellum or basal ganglia, is emerging as a promising therapeutic strategy in a subset of DCP patients.

What Is Cerebral Palsy?

A collection of conditions known as cerebral palsy (CP) have an impact on a person’s ability to move, balance, and maintain posture. The most prevalent motor impairment in kids is cerebral palsy (CP). Having to do with the brain is what is meant by cerebral. Palsy is a term used to describe muscle weakness or functional issues. Damage to the growing brain or aberrant brain development that impairs a person’s capacity to regulate their muscles is the cause of cerebral palsy (CP).

Everyone experiences CP symptoms differently. If CP is severe, the individual may need to walk with the use of specialized equipment or may not be able to walk at all and require lifelong care. While a person with mild CP could walk a little awkwardly, they might not require any extra assistance. Although the precise symptoms of CP can alter over the course of a person’s lifetime, the condition does not get worse.

Movement and posture are issues that all CP patients experience. Many additionally suffer from associated disorders like intellectual incapacity, seizures, difficulties speaking or hearing, issues with vision, hearing, or speech, alterations to the spine (like scoliosis), or joint issues (such as contractures).

What Are The Causes Of Cerebral Palsy?

A child’s ability to regulate their muscles is compromised due to aberrant brain development or damage to the growing brain, which results in CP. The abnormal growth or damage could have any number of different reasons. People once believed that the main cause of CP was a lack of oxygen during labor. Now, researchers believe that a relatively small number of CP cases are caused by this.

The abnormal brain growth or damage that causes CP can occur prior to birth, during labor and delivery, within a month after birth, or during a child’s first few years of life, while the brain is still developing. Congenital cerebral palsy (CP) refers to an injury to the brain or abnormal brain development that occurred before or during birth. 85% to 90% of CP cases are congenital. Many times, the precise reason is unknown. A minor portion of cerebral palsy is brought on by aberrant brain growth or injury that develops more than 28 days after birth. This condition is known as acquired CP and is frequently linked to a brain injury or illness (such as meningitis).

Dystonia Treatment With DBS

As a safe and efficient neuromodulation technology, deep brain stimulation (DBS) has been utilized to treat a variety of disorders. The use of DBS may be advantageous for a large number of people with movement problems like dyskinesia. Patients often ask is dystonia curable? Medical therapies are typically ineffective or only temporarily effective in treating cerebral palsy (CP), particularly for dyskinetic CP, which is a group of chronic illnesses primarily characterized by motor dysfunction. A further method for treating CP can be DBS.

A surgical procedure known as deep brain stimulation (DBS) uses an implanted device to give electronic stimulation to deep brain regions.

Two wires connecting a small, battery-operated stimulator to specific locations in the brain are implanted in the chest. The electrical stimulation that the wire ends emit helps lessen seizures or the signs and symptoms of movement disorders like dystonia.

DBS is thought to be a treatment for those with hereditary dystonia or dystonia without a known etiology whose symptoms are severe and who are not sufficiently treated by medicines. For people with acquired dystonia, such as cerebral palsy, it is occasionally viewed as a viable option.

How Is DBS Performed?

During your child’s general anesthesia, a deep brain stimulation procedure is performed.

Just big enough for the two DBS electrodes to fit through, two scalp incisions are made, as well as a small skull opening. The thickness of these electrodes is comparable to a spaghetti thread. The neurosurgeon precisely implants the electrodes where they will be most successful in regulating movement symptoms or seizures using a mix of magnetic resonance imaging (MRI) and real-time electrical recordings of the brain’s cells.

A small incision is made in the chest to insert the battery-operated stimulator, which is then wired up just below the skin. The stimulator and electrodes are connected via these lines.

In order to establish whether your child is likely to benefit from DBS and to pinpoint the parts of the brain where the implanted electrodes will work best, tests will be performed before your child has DBS surgery. For the surgical team to be able to see the electrode targets during deep brain stimulation, a sophisticated MRI is necessary. As part of the physical neurological examinations, our experienced neurologists will also do several tests.

With the use of these tests, the surgical team can pinpoint the precise areas that need to be treated. The operation is designed to insert the wire ends in precisely these locations and to place the stimulator device where it will be least visible under the skin of your child’s chest.

Care After DBS Surgery

A few weeks after surgery, your child will come back for a follow-up appointment with our DBS specialists to have the stimulator activated. Your child’s doctor will be able to modify the stimulator’s settings to determine the ideal charge level and pulse timing during follow-up appointments in the weeks and months after the device is turned on.

After that, it will be necessary to schedule routine follow-up appointments so that the stimulator setting may be maintained and the battery level checked. The majority of dystonic kids who receive DBS will still take their dystonia medications, but the dosage will be changed over time for optimal results and symptom relief.

Although deep brain stimulation lessens the frequency and intensity of seizures, it does not completely stop seizure activity. The stimulator’s settings can be improved over time to further lessen the frequency of seizures.



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