Deep brain stimulation of bilateral subthalamic nucleus for the treatment of drug-refractory Meige syndrome

Abstract

Objective To explore the therapeutic effect of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in the treatment of refractory Meige syndrome (MS). Methods A total of 32 patients with MS who underwent STN-DBS at Department of Functional Neurosurgery, Aviation General Hospital of China Medical University from May 2014 to July 2017 were retrospectively enrolled into this study. The Burke-Fahn-Marsden Dystonia Disorder Scale (BFMDRS) was used to assess the improvement of clinical symptoms. The patient′s programmed parameters were documented as well. Results All 32 patients were successfully operated. No serious complications such as intracranial hemorrhage, wound infection, allergic reaction or electrical stimulator equipment failure occurred during perioperative period. Ten patients (31.3%) had varying degrees of dyskinesia during postoperative programing, which was improved at a certain level after adjustment of programmed parameters. One patient (3.1%) had psychiatric symptoms after surgery, and the mental symptoms disappeared 3 days after treatment. The postoperative follow-up time was >12 months. The improvement rates (median) of BFMDRS scores at 3, 6, and 12 months after surgery were 76.9%, 81.4%, and 82.8%, respectively. Among them, 18 patients were followed up for >24 months, and the improvement rate (median) was 82.5% at 24 months after surgery. All 32 patients were treated with unipolar stimulation mode, which was changed to double negative stimulation mode in 2 cases due to poor effects. The stimulation voltage was 0.8-3.4 V at 12 months postoperatively, the stimulation pulse width was 50-90 μs, and the stimulation frequency was 100-175 Hz. There was no significant increase or decrease in the programmed parameters of 32 patients between 3 and 12 months post operation. Conclusions STN-DBS seems safe and effective for patients with drug-resistant MS. Postoperative programming is relatively easy with parameters varying in a small scope. Key words: Meige syndrome; Dystonia; Subthalamic nucleus; Deep brain stimulation; Prognosis