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Accuracy of stimulating electrode placement in paediatric pallidal deep brain stimulation for primary and secondary dystonia

  • Clinical Article - Functional
  • Published:
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Abstract

Background

Accuracy of electrode placement is an important determinant of outcome following deep brain stimulation (DBS) surgery. Data on accuracy of electrode placement into the globus pallidum interna (GPi) in paediatric patients is limited, particularly those with non-primary dystonia who often have smaller GPi. Pallidal DBS is known to be more effective in the treatment of primary dystonia compared with secondary dystonia.

Objectives

We aimed to determine if accuracy of pallidal electrode placement differed between primary, secondary and NBIA (neuronal degeneration and brain iron accumulation) associated dystonia and how this related to motor outcome following surgery.

Methods

A retrospective review of a consecutive cohort of children and young people undergoing DBS surgery in a single centre. Fused in frame preoperative planning magnetic resonance imaging (MRI) and postoperative computed tomography (CT) brain scans were used to determine the accuracy of placement of DBS electrode tip in Leskell stereotactic system compared with the planned target. The differences along X, Y, and Z coordinates were calculated, as was the Euclidean distance of electrode tip from the target. The relationship between proximity to target and change in Burke-Fahn-Marsden Dystonia Rating Scale at 1 year was also measured.

Results

Data were collected from 88 electrodes placed in 42 patients (14 primary dystonia, 18 secondary dystonia and 10 NBIA associated dystonia). Median differences between planned target and actual position were: left-side X-axis 1.05 mm, Y-axis 0.85 mm, Z-axis 0.94 mm and Euclidean difference 2.04 mm; right-side X-axis 1.28 mm, Y-axis 0.70 mm, Z-axis 0.70 mm and Euclidean difference 2.45 mm. Accuracy did not differ between left and right-sided electrodes. No difference in accuracy was seen between primary, secondary or NBIA associated dystonia. Dystonia reduction at 1 year post surgery did not appear to relate to proximity of implanted electrode to surgical target across the cohort.

Conclusions

Accuracy of surgical placement did not differ between primary, secondary or NBIA associated dystonia. Decreased efficacy of pallidal DBS in secondary and NBIA associated dystonia is unlikely to be related to difficulties in achieving the planned electrode placement.

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Authors and Affiliations

  1. Complex Motor Disorders Service, Evelina Children’s Hospital, Guy’s & St Thomas’ NHS Foundation Trust, Lambeth Palace Road, London, SE1 7EH, UK

    Daniel E. Lumsden & Jean-Pierre Lin

  2. Department of Medical Physics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Jonathan Ashmore & Geoff Charles-Edwards

  3. Functional Neurosurgery, King’s College Hospital NHS Foundation Trust, London, UK

    Keyoumars Ashkan & Richard Selway

  4. Clinical Neurosciences, Institute of Psychiatry, London, UK

    Keyoumars Ashkan

Authors
  1. Daniel E. Lumsden
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  2. Jonathan Ashmore
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  3. Geoff Charles-Edwards
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  4. Jean-Pierre Lin
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  5. Keyoumars Ashkan
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  6. Richard Selway
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Correspondence to Daniel E. Lumsden.

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Richard Selway and Keyoumars Ashkan have contributed equally to this paper

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Lumsden, D.E., Ashmore, J., Charles-Edwards, G. et al. Accuracy of stimulating electrode placement in paediatric pallidal deep brain stimulation for primary and secondary dystonia. Acta Neurochir 155, 823–836 (2013). https://doi.org/10.1007/s00701-013-1629-9

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  • DOI: https://doi.org/10.1007/s00701-013-1629-9

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