Pioneering Doctors Pilot New Advanced Deep Brain Stimulation Technology

Main Category: Neurology / Neuroscience
Article Date: 16 Jan 2009 - 4:00 PST

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A five-year-old boy weighing just 12.6 kg has become one of the smallest patients to ever undergo deep brain stimulation in the UK following a challenging operation carried out just before New Year.

In a further UK first the child was given a new state-of-the-art implant to stimulate his brain which is rechargeable and can operate for almost a decade - a huge improvement on first generation implants which are both larger and require surgical replacement every two years when disorders are severe.

The patient, Thomas Melville-Ross of Buckinghamshire, and his twin sister, Alice, suffer from a severe dystonia secondary to being born extremely prematurely at 24 weeks instead of the normal 40 weeks. Dystonia is a neurological movement disorder affecting more than 40,000 people in the UK. Dystonia causes involuntary muscle contractions which lead the affected parts of the body to develop abnormal movements or postures.

For many years doctors have been treating such conditions with deep brain stimulation where a surgically implanted medical device similar to a pacemaker is inserted into the brain. The implant delivers controlled electrical pulses to affected areas of the brain to block out the signals which cause the disabling movements.

Previously however Thomas would have been unable to benefit from the treatment as the existing devices were too large to be inserted in someone so small. The delay in starting treatment would have had increased implications on his future quality of life as doctors believe that the years before the age of eleven are the most important in terms of neurological development.

Thanks though to the use for the first time in the UK of the Activa RC device he was put forward for treatment. Under the care of the internationally recognised partnership between the Foundation Trusts of Guy's and St Thomas' and King's College Hospital, Thomas underwent a successful operation on December 30. Thomas is under the long-term care of doctors at the Evelina Children's Hospital, part of Guy's and St Thomas' Foundation Trust, but the operation was carried out by specialist neurosurgeons at King's.

It is likely that the deep brain stimulation will take around three months to begin to make an impact. Ultimately it is hoped that Thomas will reach a level where he may be able increase his functional independence, to include improved stillness or greater physical activity.

Jean-Pierre Lin, Consultant Paediatric Neurologist at Guy's and St Thomas', said: "Premature babies like Thomas are often affected by dystonia but because they develop smaller physically it has been impossible to give them early treatment. As a result they have gone on to suffer a poor quality of life and also a number of knock on problems such as spinal and hip injuries. This new device means we can try and help manage their conditions from a far earlier age. This should also benefit patients suffering from Parkinson's and essential tremor."

Mr Richard Selway, Consultant Functional Neurosurgeon at King's College Hospital, said: "In addition to being smaller, the fact the new device is rechargeable is a massive benefit to the patient. Previously I would have had to perform this operation every two years to replace the device which severely inconveniences the patient and places them at increased risk of infection. This offers exciting possibilities and we anticipate being able to treat a lot more young children in the coming years."

The work of the internationally recognised teams at the two hospitals was made possible by the Guy's and St Thomas' Charity which awarded a grant of £308,000 to bring the team of specialists who cared for Thomas together. Their funding ensured that this new service, unparalleled in the UK, is made available to children locally and nationally.

Geoffrey Shepherd, Chief Executive at the Charity said: "The Charity was very pleased to award a grant which has facilitated ground breaking treatment for young patients with complex motor disorders. We hope to continue to support new innovations in child care which encourage partnership working between clinicians and professional staff within the Academic Health Sciences Centre."

-- Guy's and St Thomas' provides around ¾ million patient contacts in acute and specialist hospital services every year. As one of the biggest NHS Trusts in the UK, it employs over 9,000 staff. The Trust works in partnership with the Schools of Medicine, Dentistry, Nursing and Biomedical Sciences of King's College London and other Higher Education Institutes to deliver high quality education and research. Website: http://www.guysandstthomas.nhs.uk

-- King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are working together to create a world-leading Academic Health Sciences Centre (AHSC). Our AHSC brings together an unrivalled range and depth of clinical and research expertise, spanning both physical and mental health. Our combined strengths will drive improvements in care for patients, allowing them to benefit from breakthroughs in medical science and receive leading edge treatment at the earliest possible opportunity. For more information, visit http://www.londonsahsc.org.

-- Guy's and St Thomas' Charity is the largest NHS-related charity in the UK, investing in improvements to the NHS in Lambeth and Southwark. Beneficiaries include Guy's and St Thomas' NHS Foundation Trust, Lambeth and Southwark Primary Care Trusts, South London and Maudsley NHS Foundation Trust and their academic research partners such as King's College London. The Charity's funding helps support new services and innovations in the health services and fund research infrastructure as well as the translation of laboratory research into clinical practice. The Charity maintains the collection of art and heritage at Guy's and St Thomas' and commissions new works of art to enhance the environment at local healthcare centres. Find out more on the Charity's website: http://www.gsttcharity.org.uk

Source
Guy's and St Thomas' Charity