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Ataxia
Bradykinesia
Choreoathetosis
Corticobasal Degeneration
Dyskinesias (Paroxysmal)
Dystonia
Essential Tremor
Hereditary Spastic Paraplegia
Huntington's Disease
Multiple System Atrophy
Myoclonus
Parkinson's Disease
Progressive Supranuclear Palsy
Restless Legs Syndrome
Rett Syndrome
Spasticity
Sydenham's Chorea
Tardive Dyskinesia
Tics
Tourette's Syndrome
Tremor
Wilson Disease
 

Treatment of Pediatric Movement Disorders

Surgery: Deep Brain Lesion

There is a long history of making lesions in the thalamus and basal ganglia as a treatment for tremor, parkinsonism, chorea, and dystonia. Modern, advanced neurosurgical techniques with precise localization of the lesions have led to a significant improvement in the efficacy of these procedures.

  • Tremor may respond to lesions in the thalamus
  • Dystonia may respond to lesions in the thalamus or sensorimotor region of the internal globus pallidus
  • Parkinsonism may respond to lesions in the subthalamic nucleus or internal globus pallidus

In some cases, there has been almost complete resolution of symptoms. In children, this surgery has been used to treat severe generalized dystonia. Unfortunately, many children do not achieve benefit with these procedures or are not candidates for the procedures due to medical issues or concern over side effects. When used to treat dystonia, the benefits of a lesion in the globus pallidus may not be evident for several months. Children with dystonia due to an inherited genetic defect seem to be more likely to have good results than children with dystonia due to a brain injury. Results with treatment of chorea have been disappointing; however, continued efforts are underway. Currently, the success with deep brain stimulation (DBS) has led to a decrease in the use of lesions; there are still situations in which a lesion is more appropriate.