Complications of Deep Brain Stimulation (DBS) for dystonia in children - The challenges and 10 year experience in a large paediatric cohort
Complications of Deep Brain Stimulation (DBS) for dystonia in children - The challenges and 10 year experience in a large paediatric cohort
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DOI：
10.1016/j.ejpn.2016.07.024
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发表时间：
2017-01-01
影响因子：
3.1
通讯作者：
Lin, Jean-Pierre
中科院分区：
文献类型：
--
作者：
Kaminska, Margaret;Perides, Sarah;Lin, Jean-Pierre
脑深部电刺激（DBS）已越来越多地用于儿童和青少年的原发性和继发性运动障碍。关于硬体相关并发症的报道在这一人群和小队列患者中很少。我们报告了一个具有10年经验的大型DBS中心的DBS并发症。数据收集作为一项前瞻性审计，另外还收集了一份关于刺激器充电的问卷。129例患者进行了至少6个月的随访，平均年龄10.8岁（范围3.0-18.75），平均随访3.3岁（范围0.5-10.3），体重10.4-94.2 kg， 126例新种植体（92例Activa RC）， 69例因感染以外的原因进行了修复。26例患者年龄在7岁或以下。新植入物和修复术的手术部位感染（SSI）率为10.3%，新Activa RC低8.6%，7岁以下患者的新Activa RC更低，为4.7%（1/21）。SSI发生在前6个月内，86%的感染者需要清除整个系统。18.4%的患者出现了电极/延伸问题，4.6%的患者出现了骨折，7.7%的患者出现了功能障碍，3.8%的患者出现了短延伸，2.3%的患者出现了电极移动。其他并发症包括1例临床无症状颅内出血，皮肤侵蚀（2.3%），18.7%的Soletra/Kinetra和3.4%的Activa RC意外关闭，术后IPG部位短暂性血清肿（8%）。在收到的48份充电问卷中，38%的家庭需要更换充电器，23%的家庭在充电时经常遇到保持连接的问题。然而，83%的应答者认为充电完全没有或只有一点护理负担。我们发现，特别是7岁以下患者的DBS感染率低于先前报道，但电极，延伸，特别是充电的技术问题发生率相对较高。在为患有运动障碍的儿童提供DBS时，必须考虑到这一点。(C) 2016年欧洲儿科神经病学学会。Elsevier Ltd.出版。版权所有。
Deep brain stimulation (DBS) has been increasingly used for primary and secondary movement disorders in children and young people. Reports of hardware related complications have been sparse for this population and from small cohorts of patients.We report DBS complications from a single large DBS centre with 10 year experience.Data was collected as a prospective audit and additionally from a questionnaire on recharging of the stimulators. 129 patients with a minimum 6 months follow up were identified, mean age10.8 y (range 3.0-18.75), mean follow up 3.3y (range 0.5-10.3), weight 10.4-94.2 kg, 126 new implants (92 Activa RC) and 69 revisions for reasons other than infection. 26 patients were 7y or younger. Surgical site infections (SSI) rates were 10.3% for new implants and revisions, lower 8.6% for new Activa RC and even lower, 4.7%, for new Activa RC in patients under 7y (1/21). SSI occurred within first 6 months and necessitated total system removal in 86% of those infected. Electrode/extension problems were recorded in 18.4% of patients, fracture in 4.6% malfunction in 7.7%, short extension 3.8% and electrode migration in 2.3%. Other complications involved clinically silent intracranial bleed in 1 patient, skin erosions (2.3%), unexpected switching off in 18.7% of Soletra/Kinetra and 3.4% of Activa RC, transient seroma at IPG site in postoperative period (8%). Of the 48 returned recharging questionnaires, 38% of families required recharger replacement and 23% experienced frequent problems maintaining connection during recharging. However, 83% of responders considered recharging not at all or only a little care burden.We identified lower than previously reported DBS infection rates particularly for patients under 7 years, but relatively high incidence of technical problems with electrodes, extensions and in particular recharging. This has to be considered when offering DBS for children with movement disorders. (C) 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.