Surgical Complications of Deep Brain Stimulation in Children Across Targets and Indications: Multicenter Analysis of the CHILD-DBS Registry

Abstract

Background and objectives: Deep brain stimulation (DBS) is considered off-label and investigational in pediatric populations with some exceptions. There are limited data on the relative rates of complications after DBS across different indications and targets in children. This study aimed to evaluate the safety of DBS surgery for children with movement disorders (MDs; dystonia, chorea, or tic disorders), drug-resistant epilepsy (DRE), or neurodevelopmental disorders, namely, self-injurious behavior (SIB).

Methods: Data were collected both prospectively and retrospectively from children implanted with DBS through the North American multicenter Child and Youth CompreHensIve Longitudinal Database for Deep Brain Stimulation and included demographic, clinical, operative, and postoperative variables. Complications included infection, noninfectious surgical site findings (dehiscence or seroma), hardware-related issues (disconnection or impedance change), intracranial injury, or other complications. The primary outcome was major complications, defined as any adverse event causing permanent neurologic injury or requiring surgical intervention. The secondary outcome was minor complications, defined as nonmajor complications. Generalized linear models were used to assess for any significant associations with complications.

Results: A total of 130 children and youth (mean age 12.2 ± 4.2; range 3-18) years and weighing 12.5-126.6 kg underwent DBS. The most common indication was MD (77, 59.2%), followed by DRE (47, 36.2%) and SIB (6, 4.6%). Major complications occurred in 11.5%, with a greater likelihood in MD (n = 12, 15.6%) compared with DRE (n = 2, 4.3%; odds ratio [OR] 3.55, 95% CI 2.66-4.73, p < 0.001) and significantly associated with lower weight at surgery (p < 0.001) and urgent intervention (p = 0.028). These included infection (6.2%), hardware malfunction (3.1%), and wound dehiscence (0.8%). Minor complications were also higher with MD compared with DRE (OR 1.83, 95% CI 1.16-2.89, p = 0.010) occurring in 22 participants (16.9%; 14 MD, 7 DRE, 1 SIB), including infection (6.2%), high impedance (1.5%), unrelated hydrocephalus (0.8%), perioperative worsening of symptoms (3.8%), incidental tract hemorrhage (2.3%), and noninfectious peri-electrode cystic changes (0.8%).

Discussion: DBS-associated complications were low across multiple pediatric indications and targets, with MD associated with higher risk of major complications. Limitations include a focus on surgical postoperative complications and not stimulation-related adverse outcomes. These findings demonstrate the safety profile of DBS in children in a large cohort.