Outcomes of deep brain stimulation surgery in the management of dystonia in glutaric aciduria type 1.
Lumsden, Daniel E Tsagkaris, Stavros Cleary, Jon Champion, Michael Mundy, Helen Mostofi, Abteen Hasegawa, Harutomo McClelland, Verity M Bhattacharjee, Shakya Silverdale, Monty
Lumsden, Daniel E
Tsagkaris, Stavros
Cleary, Jon
Champion, Michael
Mundy, Helen
Mostofi, Abteen
Hasegawa, Harutomo
McClelland, Verity M
Bhattacharjee, Shakya
Silverdale, Monty
Affiliation
Guy's and St Thomas NHS Foundation Trust; Kings College London; The Dudley Group NHS Foundation Trustet al
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Publication date
2025/05/01
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Abstract
Objectives: Glutaric aciduria type 1 (GA1) is a rare autosomal recessive organic acidaemia caused by deficiency of the glutaryl-CoA dehydrogenase enzyme. We describe the outcomes following deep brain stimulation (DBS) for the management of dystonia of children and adults with glutaric aciduria type 1 (GA1). Method(s): Cases with GA1 were identified from the institutional databases of two tertiary movement disorder services. Data were extracted from clinical records using a standardised proforma, including baseline clinical characteristics, imaging and neurophysiological findings, complications post-surgery, and outcomes as measured by the Burke-Fahn-Marsden Dystonia Rating Scale (BMFDRS) motor scores and the Canadian Occupation Performance Measure (COPM). Result(s): A total of 15 children were identified aged 3-17.5 with a median age of 11.5 years at neurosurgery, and one adult undergoing DBS aged 31 years. Baseline BMFDRS motor score ranged from 58.5-114, median 105. GMFCS-equivalence level was 5 (i.e. non-ambulant) for 10/16 cases. Surgery was tolerated in all cases without evidence of metabolic decompensation. BFMDRS motor score 1-year post-surgery ranged from 57.5-108.5 (median 97.25) and at last follow-up 57.5-112 (median 104) (no statistically significant change compared to baseline at either time point, P > 0.05). COPM data were available for 11/13 children and young people (CAYP). Clinically significant improvement was reported in 7/11 at 1 year and 8/11 at last follow-up. Four CAYP transitioned to adult services. Death occurred in three cases during follow-up, in no case related to DBS. Conclusion(s): DBS may be considered as a management option for children with GA1 who have appropriately selected goals for intervention.Copyright � The Author(s) 2025.
Citation
Lumsden, D.E., Tsagkaris, S., Cleary, J. et al. Outcomes of deep brain stimulation surgery in the management of dystonia in glutaric aciduria type 1. J Neurol 272, 234 (2025). https://doi.org/10.1007/s00415-025-12942-3