Paediatric deep brain stimulation An Evidence Check rapid review brokered by the Sax Institute for the NSW Ministry of Health. October 2019. An Evidence Check rapid review brokered by the Sax Institute for NSW Ministry of Health. October 2019. This report was prepared by: Ann Scott, Joanna Duncan, David Tivey, Wendy Babidge (ASERNIP-S of the Royal Australasian College of Surgeons) October 2019 This work is copyright. It may be reproduced in whole or in part for study training purposes subject to the inclusions of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the copyright owners. Enquiries regarding this report may be directed to the: Principal Analyst Knowledge Exchange Program Sax Institute www.saxinstitute.org.au [email protected] Phone: +61 2 91889500 Suggested Citation: Scott A, Duncan J, Tivey D, Babidge W. Paediatric deep brain stimulation: an Evidence Check rapid review brokered by the Sax Institute (http://www.saxinstitute.org.au/) for the NSW Ministry of Health, 2019. Disclaimer: This Evidence Check Review was produced using the Evidence Check methodology in response to specific questions from the commissioning agency. It is not necessarily a comprehensive review of all literature relating to the topic area. It was current at the time of production (but not necessarily at the time of publication). It is reproduced for general information and third parties rely upon it at their own risk. Paediatric deep brain stimulation An Evidence Check rapid review brokered by the Sax Institute for NSW Ministry of Health. October 2019. This report was prepared by Ann Scott, Joanna Duncan, David Tivey and Wendy Babidge. ASERNIP-S of the Royal Australasian College of Surgeons Contents Glossary of terms ....................................................................................................................................................................................... 6 Abbreviations .............................................................................................................................................................................................. 8 Executive summary.................................................................................................................................................................................... 9 Background.............................................................................................................................................................................................. 9 Review questions ................................................................................................................................................................................... 9 Summary of methods .......................................................................................................................................................................... 9 Key findings ............................................................................................................................................................................................. 9 Gaps in the evidence ........................................................................................................................................................................ 10 Discussion of key findings .............................................................................................................................................................. 11 Conclusion ............................................................................................................................................................................................ 11 Background ............................................................................................................................................................................................... 12 Dystonia in childhood and adolescence ................................................................................................................................... 12 Current treatments ............................................................................................................................................................................ 13 Deep brain stimulation (DBS) ........................................................................................................................................................ 14 Methods ..................................................................................................................................................................................................... 15 Study selection .................................................................................................................................................................................... 15 Evidence grading and quality appraisal .................................................................................................................................... 16 Data extraction .................................................................................................................................................................................... 17 Included studies .................................................................................................................................................................................. 17 Findings....................................................................................................................................................................................................... 20 Quality appraisal results .................................................................................................................................................................. 20 Question 1: Safety, effectiveness and cost effectiveness of DBS compared with best supportive care ......... 20 Question 2a: Effectiveness of DBS for the various types of paediatric dystonia ...................................................... 20 Predictors of outcome...................................................................................................................................................................... 25 Question 2b: Safety of DBS for the various types of paediatric dystonia ................................................................... 26 Question 3: International service delivery models and funding mechanisms for paediatric DBS .................... 27 Gaps in the evidence ........................................................................................................................................................................ 28 Limitations ............................................................................................................................................................................................. 29 Discussion .................................................................................................................................................................................................. 30 Effectiveness ......................................................................................................................................................................................... 30 Safety....................................................................................................................................................................................................... 30 Cost and access considerations.................................................................................................................................................... 31 Knowledge gaps ................................................................................................................................................................................. 31 Considerations for future research ............................................................................................................................................. 31 Conclusion ................................................................................................................................................................................................. 33 Question 1: Safety, effectiveness and cost effectiveness of DBS compared with best supportive care ......... 33 Question 2a: Effectiveness of DBS for the various types of paediatric dystonia ...................................................... 33 Question 2a: Safety of DBS for the various types of paediatric dystonia ................................................................... 33 Question 3: International service delivery models and funding mechanisms for paediatric DBS .................... 33 The bottom line .................................................................................................................................................................................. 34 Appendix 1: Literature search strategy .......................................................................................................................................... 35 Appendix 2: Included studies ............................................................................................................................................................. 38 Appendix 3: Quality appraisal results