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Micro lesion effect of pallidal deep‑brain stimulation for meige syndrome
1Department of Neurosurgery, Peking University People's Hospital, 11Th Xizhimen South St., Beijing, 100044, China.
Abstract:
To analyse the microlesion effect (MLE) in the globus pallidus interna (GPi) of deep brain stimulation (DBS) in patients with Meige syndrome. Thirty-two patients with primary Meige syndrome who underwent GPi-DBS in this study. Burke-Fahn-Marsden Dystonia Rating Scale scores (BFMDRS-M) were obtained for the evaluation of clinical symptoms at 3 days before DBS (baseline), 24 h after DBS surgery, once weekly for 1 month until electrical stimulation, 6 months postoperatively and 12 months after surgery. Twenty-seven patients had MLE after GPi-DBS. The mean time of BFMDRS-M scores maximal improvement from MLE was 35.9 h postoperatively (range, 24-48 h), and the mean scores improved by 49.35 ± 18.16%. At 12 months after surgery, the mean BFMDRS-M scores improved by 50.28 ± 29.70%. There was a positive correlation between the magnitude of MLE and the motor score at 12 months after GPi-DBS (R2 = 0.335, p < 0.05). However, there was no correlation between the duration of MLE and DBS improvement. Most Meige syndrome patients who underwent GPi-DBS and had MLE benefited from MLE. For Meige syndrome, MLE might be a predictive factor for patient clinical symptom improvement from DBS.
Insights
Microlesion effect (MLE) after globus pallidus interna deep brain stimulation (GPi-DBS) in Meige syndrome patients shows significant motor improvement. MLE magnitude correlates with long-term motor score gains, suggesting it
Area of Science:
- Neurology
- Neurosurgery
- Movement Disorders
Background:
- Meige syndrome is a rare form of focal dystonia characterized by involuntary muscle contractions, primarily affecting the face and neck.
- Deep brain stimulation (DBS) targeting the globus pallidus interna (GPi) is an established treatment for severe Meige syndrome.
- The microlesion effect (MLE), a transient neurological deficit following brain lesioning or stimulation, has been observed in GPi-DBS but its specific impact on Meige syndrome requires further analysis.
Purpose of the Study:
- To investigate the occurrence and clinical significance of the microlesion effect (MLE) in the globus pallidus interna (GPi) following deep brain stimulation (DBS) in patients diagnosed with Meige syndrome.
- To evaluate the short-term and long-term impact of MLE on motor symptom severity in Meige syndrome patients treated with GPi-DBS.
- To determine if the characteristics of MLE can serve as a predictive factor for treatment outcomes in GPi-DBS for Meige syndrome.
Main Methods:
- A cohort of 32 patients with primary Meige syndrome undergoing GPi-DBS was studied.
- Clinical symptom severity was assessed using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS-M) at baseline, 24 hours post-surgery, weekly for one month, and at 6 and 12 months postoperatively.
- The presence, duration, and maximal improvement associated with MLE were recorded, and correlations with BFMDRS-M scores were analyzed.
Main Results:
- Twenty-seven out of 32 patients (84%) experienced MLE after GPi-DBS.
- The maximal improvement in BFMDRS-M scores from MLE occurred at a mean of 35.9 hours postoperatively, with an average improvement of 49.35%.
- At 12 months post-surgery, mean BFMDRS-M scores improved by 50.28%. A positive correlation was found between the magnitude of MLE and the motor score at 12 months (R²=0.335, p<0.05), but not between MLE duration and DBS improvement.
Conclusions:
- The microlesion effect is a common occurrence following GPi-DBS in Meige syndrome patients and is associated with significant short-term motor symptom improvement.
- The magnitude of the microlesion effect appears to be a predictive factor for long-term motor outcome in Meige syndrome patients treated with GPi-DBS.
- These findings suggest that MLE may play a beneficial role in the overall efficacy of GPi-DBS for managing Meige syndrome symptoms.
