Bilateral pallidotomy to status dystonicus in children from public health system: case series and technical notes

Background: Dystonia is the second most common pediatric movement disorder after spasticity and may occasionally present as status dystonicus (SD), a life-threatening neurological emergency. Medical management of SD remains challenging and sometimes ineffective, therefore neurosurgical alternatives such as intrathecal/intraventricular baclofen administration, deep brain stimulation and pallidotomy may be needed in severe refractory cases.Objective: To evaluate the safety and effectiveness of bilateral pallidotomy in children with severe, drug-resistant dystonia, including cases of status dystonicus.Methods: This retrospective study analyzed five pediatric patients (mean age: 8.23 years) treated between January 2024 and February 2025 at a tertiary public hospital in Brazil. All had a Dystonia Severity Score (DSS) ≥3 and underwent bilateral pallidotomy. Clinical outcomes, DSS changes, medication use, and postoperative medications were assessed. Results: All patients showed clinical improvement, including resolution of status dystonicus. The average time to symptom stabilization was 6.8 days. The number of medications decreased by 22.86% postoperatively. No major complications were observed. Two patients had minor postoperative radiologic findings without clinical repercussions.Conclusion: Bilateral pallidotomy appears to be a safe and effective option in the management of severe, drug-resistant dystonia in children, particularly status dystonicus. These preliminary results highlight its potential role in selected pediatric cases. Larger studies are needed to confirm long-term efficiency and safety of bilateral pallidotomy in this context