Assistant Professor University of Pennsylvania Philadelphia, Pennsylvania, United States
Disclosure(s):
Iahn Cajigas, MD, PhD: No financial relationships to disclose
Introduction: Cerebral palsy (CP) represents the most common physical disability of childhood that encompasses a group of disorders of movement and posture attributed to non-progressive disturbances that occurred in the developmental fetal or infant brain. Most children with CP have abnormal brain MRIs indicative of cortical and deep gray matter damage consistent with hypoxic ischemic encephalopathy, which may preclude or suggest decreased efficacy of standard deep brain stimulation targets. The cerebellum has been posited as an attractive target for DCP as it is frequently spared from hypoxic ischemic damage and has shown promise in alleviating patient symptoms with deep brain stimulation (DBS).
Methods: We performed bilateral cerebellar DBS implantation, targeting the dentate nucleus and cerebellar outflow pathway, in three subjects with DCP. Leads were connected to a pulse generator that senses local field potential (LFPs) during chronic continuous DBS. Here we report our surgical methods, examples of chronic cerebellar LFP recordings, and preliminary clinical outcomes. Motor outcomes were assessed using the Bruke-Fahn-Marsden Dystonia Rating Scale (BFMDRS).
Results: Three patients ranging in age from 14-22 years old with DCP and MRI evidence of structural damage to the basal ganglia were offered cerebellar stimulation targeting the dentate nucleus (DN). All patients demonstrated improvement in subjective motor function and in objective improvement in the BFMDRS movement subscale although the range of responses was variable (19-40%). Patients experienced subjective improvement in motor function including ease of hand movements and coordination, gait, head control, speech, decreased overflow, and diminished muscle tightness.
Conclusion : DBS of the dentate nuclei in DCP appears to be safe and shows preliminary evidence of clinical benefit. New chronic sensing technology may allow for determination of in vivo mechanisms of network disruption in DCP and allow for further understanding of the effects of neuromodulation on brain physiology.
