Pallidal versus subthalamic deep-brain stimulation for meige syndrome: a retrospective study

Jiayu Liu,Zeyu Miao,Zhi Liu,Ke Xu,Dongliang Wang,Hu Ding,Jia Ouyang,Ruen Liu

doi:10.1038/s41598-021-88384-4

Jiayu Liu, Zeyu Miao + Show 6 more

Open Access

https://doi.org/10.1038/s41598-021-88384-4

Copy DOI

Abstract

Deep-brain stimulation (DBS) is an effective treatment for patients with Meige syndrome. The globus pallidus interna (GPi) and the subthalamic nucleus (STN) are accepted targets for this treatment. We compared 12-month outcomes for patients who had undergone bilateral stimulation of the GPi or STN. Forty-two Asian patients with primary Meige syndrome who underwent GPi or STN neurostimulation were recruited between September 2017 and September 2019 at the Department of Neurosurgery, Peking University People’s Hospital. The primary outcome was the change in motor function, including the Burke–Fahn–Marsden Dystonia Rating Scale movement (BFMDRS-M) and disability subscale (BFMDRS-D) at 3 days before DBS (baseline) surgery and 1, 3, 6, and 12 months after surgery. Secondary outcomes included health-related quality of life, sleep quality status, depression severity, and anxiety severity at 3 days before and 12 months after DBS surgery. Adverse events during the 12 months were also recorded. Changes in BFMDRS-M and BFMDRS-D scores at 1, 3, 6, and 12 months with DBS and without medication did not significantly differ based on the stimulation target. There were also no significant differences in the changes in health-related quality of life (36-Item Short-Form General Health Survey) and sleep quality status (Pittsburgh Sleep Quality Index) at 12 months. However, there were larger improvements in the STN than the GPi group in mean score changes on the 17-item Hamilton depression rating scale (− 3.38 vs. − 0.33 points; P = 0.014) and 14-item Hamilton anxiety rating scale (− 3.43 vs. − 0.19 points; P < 0.001). There were no significant between-group differences in the frequency or type of serious adverse events. Patients with Meige syndrome had similar improvements in motor function, quality of life and sleep after either pallidal or subthalamic stimulation. Depression and anxiety factors may reasonably be included during the selection of DBS targets for Meige syndrome.

Highlights

Deep-brain stimulation (DBS) is an effective treatment for patients with Meige syndrome
This study was designed to compare the outcomes of bilateral neurostimulation of pallidal stimulation (GPi-DBS) with that of subthalamic stimulation (STN-DBS)
The clinical characteristics of the two groups of patients were similar at baseline in terms of age (58.67 ± 6.76 years in the globus pallidus interna (GPi) group vs. 59.57 ± 9.42 years in the subthalamic nucleus (STN) group); female sex (66.7% vs. 81.0%); medication for Meige syndrome (42.9% vs. 28.6%); botulinum toxin treatment (42.9% vs. 23.8%); family history of dystonia (9.5% vs. 9.5%) and disease duration (6.21 ± 6.06 years vs. 6.39 ± 6.09 years)

Summary

Introduction

Deep-brain stimulation (DBS) is an effective treatment for patients with Meige syndrome. Patients with Meige syndrome had similar improvements in motor function, quality of life and sleep after either pallidal or subthalamic stimulation. The globus pallidus interna (GPi) is the most commonly used target of DBS in the treatment of Meige s yndrome[3,4], our recent study has demonstrated the efficacy and safety of the subthalamic nucleus (STN) as a target of DBS5. This study was designed to compare the outcomes of bilateral neurostimulation of pallidal stimulation (GPi-DBS) with that of subthalamic stimulation (STN-DBS). To our knowledge, this is the largest study assessing and comparing the efficacy of stimulating these targets in patients with Meige syndrome

Methods

Results

Conclusion