# Fatal Tracheostomy-Related Complications in a Pediatric Patient with DYT1 Dystonia After Delayed Deep Brain Stimulation

## TL;DR

A child with DYT1 dystonia had fatal airway complications after a delayed deep brain stimulation, showing risks of late intervention.

## Contribution

Highlights fatal tracheostomy complications from delayed DBS in a pediatric DYT1 dystonia case.

## Key findings

- Delayed DBS led to 47% motor improvement but fatal airway dysfunction.
- Longstanding dystonia can cause irreversible neuromuscular issues despite DBS.
- Tracheostomy in dystonia patients may carry fatal respiratory risks.

## Abstract

The DYT1 dystonia is a rare autosomal dominant disorder characterized by early-onset focal dystonia, which may progress to generalized dystonia. Deep brain stimulation (DBS) is often effective in severe or medically refractory cases. We report a pediatric patient with a DYT1 mutation who developed focal dystonia at age six, which progressed to generalized dystonia by age eight, and culminated in status dystonicus at age 12. After stabilization, he remained in a state of refractory, generalized dystonia and underwent DBS following a seven-month delay. Although motor symptoms improved by 47%, he developed progressive airway dysfunction necessitating tracheostomy, which ultimately led to fatal respiratory complications. This case highlights that delayed DBS intervention may fail to prevent irreversible structural and neuromuscular sequelae, including fatal airway compromise, in patients with longstanding dystonia.