Rechargeable Deep Brain Stimulators in the Management of Paediatric Dystonia: Well Tolerated with a Low Complication Rate

Background: Deep brain stimulation (DBS) is a recognised method of treatment for primary and secondary dystonia. The size of non-rechargeable batteries has limited their use in small children. Our severe dystonia patients have required battery replacement every 20-24 months. Objectives: To evaluate reliability, care burden, patients' satisfaction and complications related to the rechargeable neurostimulator Activa (R) RC (launched by Medtronic in Europe in autumn 2008). Methods: Complications were recorded prospectively, and a questionnaire on neurostimulator maintenance, care burden and parental satisfaction was applied to all patients with at least 3 months of follow-up. Results: 30 Activa RCs were implanted between December 2008 and June 2010, 25 with a follow-up of 3-17 months (mean 10); the mean patient's age at surgery was 11.1 years; 22/25 questionnaires were completed. All families achieved good standards of recharging. Caregivers were responsible for recharging in 82% of cases. With higher parameters of stimulation, recharging time was longer than initially recommended by the manufacturer. All but one family would recommend Activa RC to other patients. Transient recharging problems were the most common complication (36% of cases). Infection/skin erosion occurred in 8% of cases, self-resolving early seroma in 20%. Conclusions: Activa was found to offer reliable stimulation with a low rate of significant complications and a suitable treatment option for children with dystonia.