Post-operative electrode location and clinical efficacy of subthalamic nucleus deep brain stimulation in Meige syndrome

Chen Yao; Andreas Horn; Ningfei Li; Yang Lu; Zonghui Fu; Ning Wang; Tipu Z Aziz; Lin Wang; Shizhong Zhang

doi:10.1016/j.parkreldis.2018.05.014

Post-operative electrode location and clinical efficacy of subthalamic nucleus deep brain stimulation in Meige syndrome

Parkinsonism Relat Disord. 2019 Jan:58:40-45. doi: 10.1016/j.parkreldis.2018.05.014. Epub 2018 Jul 10.

Authors

Chen Yao¹, Andreas Horn², Ningfei Li³, Yang Lu⁴, Zonghui Fu⁵, Ning Wang⁵, Tipu Z Aziz⁶, Lin Wang⁷, Shizhong Zhang⁸

Affiliations

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.

PMID: 30217540
DOI: 10.1016/j.parkreldis.2018.05.014

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.

Keywords: Deep brain stimulation; Meige syndrome; Subthalamic nucleus; Volume of tissue activated (VAT).

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Deep Brain Stimulation / methods*
Electrodes, Implanted*
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Male
Meige Syndrome / diagnostic imaging*
Meige Syndrome / therapy*
Middle Aged
Outcome Assessment, Health Care*
Subthalamic Nucleus* / diagnostic imaging