Deep brain stimulation for pediatric dystonia: a meta-analysis with individual participant data.

AIM: We performed a meta-analysis with individual participant data of deep brain stimulation (DBS) for dystonia in children and young people. METHOD: Three databases (PubMed, Embase, and Web of Science) were queried from January 1999 to August 2017 with no language restrictions to identify case studies and cohort studies reporting on pediatric patients (age ≤21y) with dystonia. The primary outcomes were changes in Burke-Fahn-Marsden (BFM) or Barry-Albright Dystonia Scale scores. A mixed-effects regression was used to identify associations between clinical covariates and outcomes. RESULTS: Of 2509 citations reviewed, 72 articles (321 children) were eligible. At last follow-up (median 12mo, 25th centile=9.0; 75th centile=32.2), 277 (86.3%) patients showed improvement in dystonia, while 66.1 percent showed clinically significant (>20%) BFM Dystonia Rating Scale-motor improvement. On multivariable hierarchical regression, older age at dystonia onset, inherited dystonia without nervous system pathology and idiopathic dystonia (vs inherited with nervous system pathology or acquired dystonia), and truncal involvement indicated a better outcome (p<0.05). INTERPRETATION: The data suggest that DBS is effective and should be considered in selected children with inherited or idiopathic dystonia. WHAT THIS PAPER ADDS: Deep brain stimulation is effective in selected children with inherited or idiopathic dystonia.

Minocycline-induced transient depersonalization: A case report.

Minocycline is a medication commonly used for the treatment of acne vulgaris. The central nervous system-induced side effects of minocycline include headaches, pseudotumor cerebri, ataxia, and vestibular dysfunction. Many minocycline-related side effects have been presented in the literature, however, reports of depersonalization symptoms induced by the medication are rare. We present the case of a 37-year-old female diagnosed with perioral dermatitis treated with minocycline, who within 1 week suffered from severe depersonalization symptoms. The pathophysiologic mechanism of depersonalization induced by minocycline is unclear but various hypotheses include hypersensitivity of the serotonin system, drug-related metabolic encephalopathy, substance-induced temporal disintegration, and panic-disorder-related etiology. Depersonalization is a potentially severe and important side effect of minocycline that should be documented, further investigated, and recognized by clinicians.