London first for pioneering neurosurgical procedure at Evelina London

A teenage boy is one of the first patients in the world to undergo deep brain stimulation with a rechargeable device at Evelina London Children's Hospital.

The new device means that patients will no longer need to have repeated operations, and for the first time clinicians can access real-time data from the site of deep brain stimulation in the centre of the brain.

Sean Igbokwe, 14, from south London, was the first patient to have the new rechargeable device fitted at Evelina London, and is one of the first patients in the world.

Sean has cerebral palsy which causes uncontrolled muscular movements or spasms, known as dystonia, and has been under the care of Evelina London since he was 7. It's hoped deep brain stimulation will relieve some of the dystonic stiffness that causes his discomfort and limited mobility.

For many children and young people with dystonia, daily activities can be challenging, such as getting dressed or eating and drinking. Deep brain stimulation involves fine electrodes being implanted deep into the brain to target areas that control coordination of body movements and postures.

Sean's operation took place at the specialist children's hospital, which has the oldest and largest paediatric deep brain stimulation service in the world. Clinicians used state of the art robotic and intraoperative imaging equipment to take images of the brain during the operation.

The electrode wires pass through the skull, underneath the scalp to connect to extension wires to the new rechargeable 'sensing' pacemaker-like device under the skin of the abdomen.

When switched on, the device senses the abnormal brain waves which are recorded and stored in the pacemaker battery. In turn the device sends continuous electrical impulses through the electrode wires to change the way electrical signals are processed in the brain.

The new deep brain stimulator allows clinicians to track patient's brain rhythms and to tailor electrical impulses to improve patients' movements. It will also allow clinicians to better understand signals in the brain and the conditions which cause movement disorders.

In previously implanted devices, the battery would need to be replaced after 4 to 5 years, or if uncharged for a year, which would result in further operations for the patient. However, the new rechargeable device has unlimited lifespan due to new battery technology.

Dr Jean Pierre Lin, consultant paediatric neurologist for the complex motor disorders service at Evelina London, said:

It's hugely exciting to have undertaken our first deep brain stimulation surgery with this new device, as this will prevent patients from having to undergo future surgeries to maintain their devices.

 

It's also an excellent step forwards in helping us to understand more about the signals in a patient's brain and how they affect movements.

 

"For the first time, we'll have access to real-time data from brains to guide us towards the best deep brain stimulation patterns appropriate to each case. We will be better able to understand a patient's symptoms and can program the device in a more targeted way to control muscle movement, helping to ease symptoms quicker."

Mandah, Sean's mother, said: "This is a great opportunity for Sean to aim for an enhanced more fulfilled future. As parents we would like him to be as independent as possible, living a full happy life and experience pain free movement."

His tenacity and bravery has held him in a good stead until now; as he moves into adulthood, our wish for him is to be able to do simple things in life, things most of us take for granted like holding a glass of water or playing with siblings.

The data gathered will also feed into wider surveillance on different conditions causing dystonia and how these affect young people and their brain activity. It will help clinicians to look at rare clusters of movement disorders, and to greater understand electrical pathways in the brain over a lifetime.

Evelina London's deep brain stimulation programme began in 2003 and received funding from Guy's & St Thomas' Charity to expand, treating over 250 patients to date. The specialist service includes dedicated paediatric neurologists, clinical nurse specialists and therapists from Evelina London, and paediatric neurosurgeons from King's College Hospital.

Many patients who have undergone deep brain stimulation at Evelina London have progressed to learning to drive, higher education, and employment. Clinicians are currently following up with long-term patients for an ongoing study.