Chen Yao1, Andreas Horn2, Ningfei Li3, Yang Lu4, Zonghui Fu5, Ning Wang5, Tipu Z Aziz6, Lin Wang7, Shizhong Zhang8. 1. Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China; The National Key Clinic Specialty, The Neurosurgery Institute of Guangdong Province, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Southern Medical University, Guangzhou, China. 2. Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité-Universitätsmedizin, Berlin, Germany. 3. Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité-Universitätsmedizin, Berlin, Germany; Institute of Software Engineering and Theoretical Computer Science, Neural Information Processing Group, Technische Universität Berlin, Berlin, Germany. 4. Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China. 5. Department of Neurosurgery, Aviation General Hospital, China Medical University, Beijing, China. 6. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU, United Kingdom. 7. Department of Neurosurgery, Aviation General Hospital, China Medical University, Beijing, China. Electronic address: wanglin70321@126.com. 8. Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China; The National Key Clinic Specialty, The Neurosurgery Institute of Guangdong Province, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Southern Medical University, Guangzhou, China. Electronic address: zhangshizhong@smu.edu.cn.
Abstract
BACKGROUND: Subthalamic nucleus (STN) deep brain stimulation (DBS) has recently been shown to be an effective treatment for Meige syndrome but efficacy of symptomatic improvement and its relationship to factors in DBS remains to be explored. OBJECTIVES: This study explored the relationship of electrode contact location in bilateral STN-DBS with clinical efficacy in Meige syndrome patients through retrospective analysis. METHODS: Pre- and post-operative magnetic resonance (MR) images of Meige syndrome patients (n = 15) were analysed. Clinical outcomes were evaluated with the Burke-Fahn-Marsden Dystonia Scale (BFMDRS). The location of active contacts in Montreal Neurological Institute (MNI) standard space and volume of activated STN tissue were determined and related to clinical outcomes. RESULTS: At the last follow up (mean = 14.8 ± 4.0 months; range = 11-24 months), Meige syndrome patients (n = 14) showed improved BFMDRS scores (mean improvement = 70.9%, p = 0.001) compared to pre-operative assessment. Active contacts of stimulation given from coordinates in the MNI space (mean left side: x = -12.5 ± 1.2 mm, y = -13.3 ± 1.7 mm, z = -5.5 ± 2.5 mm; mean right side: x = 12.7 ± 1.4 mm, y = -12.7 ± 1.7 mm, z = -6.4 ± 2.4 mm) were found mainly clustered in the dorsolateral STN. While there were no significant differences in patients grouped by their degree of symptomatic improvement (<30%, 30-70% and >70%) with their respective coordinates, the volume of activated tissue within the STN of patients was significantly correlated to the BFMDRS improvement (R = 0.6, p = 0.02). CONCLUSIONS: These findings further support the stimulation of the dorsolateral STN for effective alleviation of symptoms in Meige syndrome patients and indicate that specific factors of DBS can be considered to predict clinical efficacy.
BACKGROUND: Subthalamic nucleus (STN) deep brain stimulation (DBS) has recently been shown to be an effective treatment for Meige syndrome but efficacy of symptomatic improvement and its relationship to factors in DBS remains to be explored. OBJECTIVES: This study explored the relationship of electrode contact location in bilateral STN-DBS with clinical efficacy in Meige syndromepatients through retrospective analysis. METHODS: Pre- and post-operative magnetic resonance (MR) images of Meige syndromepatients (n = 15) were analysed. Clinical outcomes were evaluated with the Burke-Fahn-Marsden Dystonia Scale (BFMDRS). The location of active contacts in Montreal Neurological Institute (MNI) standard space and volume of activated STN tissue were determined and related to clinical outcomes. RESULTS: At the last follow up (mean = 14.8 ± 4.0 months; range = 11-24 months), Meige syndromepatients (n = 14) showed improved BFMDRS scores (mean improvement = 70.9%, p = 0.001) compared to pre-operative assessment. Active contacts of stimulation given from coordinates in the MNI space (mean left side: x = -12.5 ± 1.2 mm, y = -13.3 ± 1.7 mm, z = -5.5 ± 2.5 mm; mean right side: x = 12.7 ± 1.4 mm, y = -12.7 ± 1.7 mm, z = -6.4 ± 2.4 mm) were found mainly clustered in the dorsolateral STN. While there were no significant differences in patients grouped by their degree of symptomatic improvement (<30%, 30-70% and >70%) with their respective coordinates, the volume of activated tissue within the STN of patients was significantly correlated to the BFMDRS improvement (R = 0.6, p = 0.02). CONCLUSIONS: These findings further support the stimulation of the dorsolateral STN for effective alleviation of symptoms in Meige syndromepatients and indicate that specific factors of DBS can be considered to predict clinical efficacy.
Authors: Virgilio Gerald H Evidente; Pnina Rokhlin; Maris H Evidente; Margaret Lambert; Robin Garrett; Francisco A Ponce Journal: Mov Disord Clin Pract Date: 2021-05-24