Deep Brain Stimulation for Dystonia: Experience of a Moroccan University Hospital

Pediatr Neurol. 2023 Nov:148:23-27. doi: 10.1016/j.pediatrneurol.2023.08.002. Epub 2023 Aug 9.

Abstract

Background: Deep brain stimulation (DBS) is a well-established procedure that provides long-term symptom control of the third most common movement disorder: dystonia. In this study, we aim to report the experience of Ibn Rochd University Hospital in the treatment of dystonia using DBS of the globus pallidus internus, which represents an exceptional challenge for a developing country such as Morocco.

Methods: Since 2013, we selected five eligible candidates for DBS surgery at the university hospital Ibn Rochd. A genetic assessment had been performed in four cases. Their motor and mental states were prospectively monitored using several validated scales, including Burke-Fahn-Marsden Dystonia Rating Scale, Mini Mental State Examination, 36-Item Short Form Survey, and Zarit scale.

Results: Our sample had two clinical phenotypes of dystonia: isolated dystonia (in two patients) and combined dystonia (in three patients). Patients were aged 14 to 32 years, and their mean onset age ranged from 7 to 13 years with a mean progression duration of 9 years. Our results indicate successful treatment of patients with dystonia using DBS. Scores from the Burke-Fahn-Marsden Dystonia Rating Scale confirm improvements ranging from 40% to 95%. However, some potentially surgery-related complications could occur such as lead infection, which, in our experience, was reported in one case.

Conclusion: The experience of the university hospital Ibn Rochd regarding the use of DBS in treating dystonia was largely positive. However, the procedure faces challenges due to its complexity, specifically concerning its multidisciplinary nature, its genetic test costs, and the reluctance of pediatricians to get involved.

Keywords: Deep brain stimulation; Dystonia; Morocco; Movement disorders.

MeSH terms

  • Adolescent
  • Child
  • Deep Brain Stimulation* / adverse effects
  • Deep Brain Stimulation* / methods
  • Dystonia* / diagnosis
  • Dystonia* / therapy
  • Dystonic Disorders* / etiology
  • Globus Pallidus
  • Hospitals
  • Humans
  • Treatment Outcome

Supplementary concepts

  • Fatty Acid Hydroxylase-Associated Neurodegeneration