Simultaneous pallidal and centromedian deep brain stimulation for combined dystonia and drug-resistant epilepsy in a child with hypoxic-ischemic encephalopathy: a technical case report.

PURPOSE: Children with hypoxic-ischemic encephalopathy (HIE) frequently exhibit both dystonia and drug-resistant generalized epilepsy, reflecting injury to parallel but distinct motor and thalamocortical networks. Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is established for secondary dystonia, and centromedian nucleus (CMN) DBS has recently demonstrated safety and efficacy for Lennox-Gastaut syndrome in the ESTEL trial. We describe the technical feasibility of simultaneous bilateral GPi and CMN DBS in an 8-year-old boy with HIE.

METHODS

Four DBS leads were implanted in one session using robotic stereotaxy, targeting bilateral GPi and CMN via a combination of direct and indirect targeting. Perioperative workflow, early postoperative findings, and initial programming are detailed.

RESULTS

Postoperative imaging confirmed accurate placement of the leads. GPi leads were turned on prior to discharge on postoperative day 1 without side effects. At 3 weeks post-op, the patient presented with well-healed incisions and subjective improvement in lower extremity tone. The CMN system was activated successfully at the first programming visit.

CONCLUSION

Dual-target DBS is feasible and safe in pediatric patients. This approach permits simultaneous modulation of non-overlapping basal-ganglia and thalamocortical circuits underlying dystonia and generalized epilepsy.