A Stimulating Topic

May 26, 2009
Warren Marks, MD

MDNG Neurology, April 2009, Volume 11, Issue 2

Thanks to new technologies, children are receiving state-of-the-art neurological care at Cook Children's Medical Center.

Thanks to new technologies, children are receiving state-of-the-art neurological care at Cook Children’s Medical Center

For three years, Steven never spoke to his family. This was not because of some petty family squabble; Steven, 28, sustained a closed head injury as a child when he was hit by a car while riding a bicycle. Several years after the accident, he began having difficulty walking. Unfortunately, his neurological deterioration proved to be progressive, affecting his motor and cognitive skills. He stopped walking in 2004, and eventually developed a seizure disorder. His dystonia worsened, and his speech also deteriorated to the point that he could no longer communicate.

Medication helped for a while. But when drugs and other treatments failed, Steven needed something dramatic to change his life. In April 2007, Steven was the second patient at Cook Children’s Medical Center in Fort Worth, TX to undergo deep brain stimulation (DBS) surgery. Since then, his movement has improved, but more importantly, he is once again able to speak.

As any neurologist or neurosurgeon knows, there are major differences between treating children and treating adults. At Cook Children’s, we proved that we could perform this surgery on adults with patients such as Steven, but we only did so because he had been treated at our hospital since he was a young boy and we knew his history.

This is an exciting time to be a neurologist, especially at Cook Children’s Medical Center, where we apply state-of-the-art solutions to patient care, always looking for innovative treatments to better serve our patients. Cook Children’s is the first independent pediatric hospital in Texas to offer DBS as part of a comprehensive children’s movement disorder program.

Our staff is excited about where the Movement Disorder and Neurorehabilitation Program is headed. As of October 2008, we have completed 15 DBS surgeries, with patients ranging in age from age 7 to 28 years. The majority of patients treated at Cook Children’s have dystonia, but DBS surgery also helps with other movement disorders, including Parkinson’s disease and tremors. Although patients may not see improvement for three to six months after the surgery, we have seen some amazing results with Steven and other patients, including dramatic tremor reductions and drastically slowed progression of dystonia.

Deep brain stimulation is a surgical procedure involving the placement deep into the brain of electrodes that are connected to implanted medical devices sometimes referred to as a brain pacemaker. The electrodes deliver constant small electrical impulses to a small region of the brain in order to treat otherwise treatment-resistant movement disorders. Surgery may last up to eight hours, with the patient conscious the majority of the time, allowing the surgeons to better assess the progress of the surgery and helping ensure accurate placement of the deep brain stimulators. Throughout the entire surgical process, one of our Child Life specialists, who has expertise in child development and psychology, stays with the patient to provide comfort and support.

With the support of the hospital and the community, The DBS program at Cook Children’s has a dedicated multi-disciplinary team of more than 25 members, including neurosurgeons, neurologists, anesthesiologists, nurses, therapists, technicians, and Child Life specialists. The extensive involvement of the Child Life specialist is an important and unique aspect of the Cook Children’s DBS program that really sets it apart from other programs. A Child Life specialist helps explain the surgery to patients at a developmentally age-appropriate level and meets with patients the day before the surgery to establish a relationship with them.

At Cook Children’s, we are dedicated to providing state-of-the-art care in a child-friendly environment. I’m really excited about our ability to apply these new and innovative approaches to solving some very complex patient care challenges.

Dr. Marks is the Medical Director at Cook Children’s Medical Center Movement Disorder and Neurorehabilitation Program, Fort Worth, TX.