Deep Brain Stimulation Promising Treatment for Cerebral Palsy

Posted on: Tuesday, 7 July 2009, 06:59 CDT

Deep brain stimulation may improve movement and quality of life in patients with a subtype of cerebral palsy (CP) and could be an effective treatment option. Cerebral palsy with dystonia-choreoathetosis is a common and progressively disabling disorder in children and adults for which no effective treatment currently exists.
Bilateral pallidal deep brain stimulation (BP-DBS), a surgical procedure in which electrodes are implanted to stimulate parts of the brain to reduce involuntary movements and tremors, has been shown to be an effective treatment for primary generalized dystonia. However, the effect of this treatment on a secondary dystonia such as dystonia-choreoathetosis is not clear.
To investigate the effect of BP-DBS on movement skills, functional ability, and quality of life, Marie Vidailhet and colleagues of Salpetriere Hospital, France, implanted leads in the globus pallidus internus (GPi) area of the brain of 13 patients with dystonia-choreoathetosis CP. All patients were evaluated for changes in the severity of dystonia-choreoathetosis using the Burke-Fahn-Marsden dystonia rating scale before surgery and again after 12 months of continuous neurostimulation. Quality of life, cognitive function, and mood also were assessed.
After one year, BP-DBS resulted in improvement in the Burke-Fahn-Marsden dystonia rating scale movement score in a majority of patients. Eight patients showed between 21 percent and 55 percent improvement; two patients showed little benefit; and three had no benefit or deteriorated slightly.
Importantly, functional disability, pain, mental health-related quality of life, and social interaction seemed to improve, and there was no worsening of cognition or mood.
The authors report one key factor to a good outcome is the optimal placement of leads in the GPi area of the brain. Patients with leads positioned outside the boundaries of the GPi showed no beneficial effect.
Despite promising findings, researchers note that the study involved a small number of patients and should be interpreted with caution. They call for further studies to evaluate the effect of DBS on more complex and common types of CP, particularly in children.
SOURCE: Lancet Neurology, July 2009
Source: Ivanhoe