Bilateral globus pallidus internus deep brain stimulation for XXXX supports success of cochlear implantation in a 5-year old ex-24  week preterm twin with absent cerebellar hemispheres.

@entity1 @entity3520 @entity910 @entity2319 @entity281 @entity3519 @entity717 @entity159 @entity306
BACKGROUND: Early onset @entity3519 ( @entity910 ) and @entity2319 in childhood pose significant challenges for @entity1 and carers and are the cause of @entity717 . It is particularly tragic when the @entity1 cannot make use of early cochlear implantation (CI) technology to relieve @entity2319 and improve language and communication, because severe cervical and truncal @entity3519 brushes off the magnetic amplifier behind the ears. Bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) neuromodulation can reduce @entity910 , thus supporting CI neuromodulation success. METHODS: We describe the importance of the order of dual neuromodulation surgery for @entity3519 and @entity2319 . First with bilateral GPi DBS using a rechargeable ACTIVA-RC neurostimulator followed 5 months later by unilateral CI with a Harmony (BTE) Advanced Bionics Hi Res 90  K cochlear device. This double neuromodulation was performed in series in a 12.5  kg 5 year-old ex-24 week gestation-born twin without a cerebellum. RESULTS: Relief of @entity910 enabled continuous use of the CI amplifier. Language understanding and communication improved. @entity3520 abated. Tolerance of sitting increased with emergence of manual function. @entity159 ensued 10 days after ACTIVA-RC removal for @entity281 at 3 years and 10 months. He required intensive care and DBS re-implantation 3 weeks later together with 8 months of hospital care. Today he is virtually back to the level of functioning before the DBS removal in 2012 and background medication continues to be slowly weaned. CONCLUSION: This case illustrates that early neuromodulation with DBS for @entity306 followed by CI for @entity2319 is beneficial. Both should be considered early i.e. under the age of five years. The DBS should precede the CI to maximise @entity3519 reduction and thus benefits from CI. This requires close working between the paediatric DBS and CI services.
