Long-term clinical outcome of bilateral pallidal stimulation for intractable craniocervical dystonia (Meige syndrome). Report of 6 patients

Sobstyl, Michał; Brzuszkiewicz-Kuźmicka, Grażyna; Zaczyński, Artur; Pasterski, Tomasz; Aleksandrowicz, Marta; Ząbek, Mirosław

doi:10.1016/j.jns.2017.10.017

Cited by 17 publications

(14 citation statements)

References 23 publications

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“…Bilateral GPi DBS has been shown to improve the swallowing function in majority of the studies in patients with Meige syndrome, as demonstrated by improved Burke–Fahn–Masden Dystonia Rating Scale (BFMDRS) speech and swallowing scores in 12 patients who followed up to 38 months on average ( 29 ), in 11 patients who followed up for 23 months on average ( 30 ), in 6 patients who followed up to 60 months ( 31 ), and in 40 patients who followed up at 6, 12, and 24 months after surgery ( 32 ). There was one study by Limotai et al in six patients with Meige syndrome, with one unilateral and five bilateral GPi, evaluated 6 and 12 months after DSB for Unified Dystonia Rating Scale (UDRS) and BFMDR speech and swallowing function, but they did not find improvement in speech and swallowing function in this cohort ( 50 ).…”

Section: Resultsmentioning

confidence: 99%

“…Targeting GPi seemed to have positive results on Meige syndrome in the majority of the studies (29)(30)(31)(32). One of the possibilities behind the benefit is the direct effect on the pharyngeal and laryngeal dystonia by GPi, which could help to improve dysphagia symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…DBS targeting the post-subthalamic area and caudal zona incerta (PSA/cZi) was thought to be associated with fewer side effects compared to ventralis intermedius (ViM) or STN (21), including the swallowing function (22)(23)(24). GPi DBS has also been used to treat various dystonia (25)(26)(27)(28), including Meige syndrome (29)(30)(31)(32), and its effect on the swallowing function is also of interest to review compared to that in PD.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Deep Brain Stimulation on Swallowing Function: A Systematic Review

Takahashi

Bloom

et al. 2020

Front. Neurol.

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The effect of deep brain stimulation (DBS) on swallowing function in movement disorders is unclear. Here, we systematically reviewed this topic by searching keywords following PICOS strategy of problem (swallowing or swallow or dysphagia or aspiration) and intervention (deep brain stimulation, or DBS) in the PubMed and Web of Science in English in April 2020, with comparators [subthalamic nucleus (STN), globus pallidus interna (GPi), ventralis intermedius, (ViM), post-subthalamic area, or caudal zona incerta (PSA/cZi); ON/OFF DBS state/settings, ON/OFF medication state, Parkinson's disease (PD), dystonia, tremor], outcomes (swallowing function measures, subjective/objective) and study types (good quality original studies) in mind. We found that STN DBS at usual high-frequency stimulation could have beneficial effect (more so on subjective measures and/or OFF medication), no effect, or detrimental effect (more so on objective measures and/or ON medication) on swallowing function in patients with PD, while low-frequency stimulation (LFS) could have beneficial effect on swallowing function in patients with freezing of gait. GPi DBS could have a beneficial effect (regardless of medication state and outcome measures) or no effect, but no detrimental effect, on swallowing function in PD. GPi DBS also has beneficial effects on swallowing function in majority of the studies on Meige syndrome but not in other diseases with dystonia. PSA/cZi DBS rarely has detrimental effect on swallowing functions in patients with PD or tremor. There is limited information on ViM to assess. Information on swallowing function by DBS remains limited. Well-designed studies and direct comparison of targets are further needed.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Deep Brain Stimulation on Swallowing Function: A Systematic Review

Takahashi

Bloom

et al. 2020

Front. Neurol.

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“…The HD patients recruited in this study had less severe dystonic symptoms compared to the dystonia patients, so the elevated low frequency band power may reflect the dystonic syndrome rather than the disease itself. The second question is whether idiopathic dystonia responds well to GPi-DBS ( 32 – 34 ), as the dystonic syndrome in HD does not ( 35 ). Based on this study, we conclude that the dystonic syndrome in HD is not that prominent compared to dystonia and DBS may most strongly suppress the prominent frequency band.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Globus Pallidus Internus Local Field Potentials in Hyperkinetic Disease

et al. 2018

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Background: Dystonia and Huntington's disease (HD) are both hyperkinetic movement disorders but exhibit distinct clinical characteristics. Aberrant output from the globus pallidus internus (GPi) is involved in the pathophysiology of both HD and dystonia, and deep brain stimulation (DBS) of the GPi shows good clinical efficacy in both disorders. The electrode externalized period provides an opportunity to record local field potentials (LFPs) from the GPi to examine if activity patterns differ between hyperkinetic disorders and are associated with specific clinical characteristics.Methods: LFPs were recorded from 7 chorea-dominant HD and nine cervical dystonia patients. Differences in oscillatory activities were compared by power spectrum and Lempel-Ziv complexity (LZC). The discrepancy band power ratio was used to control for the influence of absolute power differences between groups. We further identified discrepant frequency bands and frequency band ratios for each subject and examined the correlations with clinical scores.Results: Dystonia patients exhibited greater low frequency power (6–14 Hz) while HD patients demonstrated greater high-beta and low-gamma power (26–43 Hz) (p < 0.0298, corrected). United Huntington Disease Rating Scale chorea sub-score was positively correlated with 26–43 Hz frequency band power and negatively correlated with the 6–14 Hz/26–43 Hz band power ratio.Conclusion: Dystonia and HD are characterized by distinct oscillatory activity patterns, which may relate to distinct clinical characteristics. Specifically, chorea may be related to elevated high-beta and low-gamma band power, while dystonia may be related to elevated low frequency band power. These LFPs may be useful biomarkers for adaptive DBS to treat hyperkinetic diseases.

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“…Surgical treatment becomes an option when conservative treatment is not effective. Deep brain stimulation (DBS) has been widely used to treat primary dystonia [5,26,27], but only a few studies on DBS for Meige syndrome are available [10,16,19,20,28,32]. To evaluate the long-term e cacy and safety of globus pallidus internus (GPi) DBS in the treatment of Meige syndrome, we summarized the long-term follow-up data of 13 patients with Meige syndrome who underwent GPi DBS.…”

Section: Introductionmentioning

confidence: 99%

Long-term Efficacy of GPi DBS for Cranio Facial Dystonia: a Retrospective Report of 13 Cases

Ren

Wen

Wang

et al. 2021

Preprint

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Objective: This study evaluated the long-term efficacy of globus pallidus internus (GPi) deep brain stimulation (DBS) in the treatment of Cranio Facial dystonia (Meige syndrome) and investigated the correlation between the volume of tissue activated (VTA) of the GPi and each subregion and movement score improvement.Methods: We retrospectively analyzed the clinical data of 13 patients with drug-refractory Meige syndrome who were treated with GPi DBS. Pre- and postoperative Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores were compared. Relationships between preoperative baseline variables and improvement in the BFMDRS-Movement (BFMDRS-M) score were analyzed. LEAD-DBS software was used for three-dimensional reconstruction of the GPi and implanted electrodes. Correlations between the GPi-VTA and score improvement were analyzed.Results: The average follow-up period was 36.6±11.0 months (18-55 months). The improvements in the BFMDRS-M score were 58.2% and 54.6% at 3 months after stimulation and at the final follow-up visit, respectively, and the improvements in the BFMDRS-Disability (BFMDRS-D) score were 53.6% and 51.7%, respectively. At the final follow-up visit, the improvements in BFMDRS-M scores for the eye, mouth, and speech/swallowing were significant (P<0.001). Age was an independent predictor of improvement in the BFMDRS-M score after DBS (P=0.005). A decrease in the BFMDRS-M score had significant positive relationships with the GPi-VTA (r=0.757, P=0.003). Conclusions: GPi DBS is an effective method to treat drug-refractory Meige syndrome. LEAD-DBS software can be used as an effective aid for visualization programing after DBS.

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Long-term clinical outcome of bilateral pallidal stimulation for intractable craniocervical dystonia (Meige syndrome). Report of 6 patients

Cited by 17 publications

References 23 publications

Effect of Deep Brain Stimulation on Swallowing Function: A Systematic Review

Effect of Deep Brain Stimulation on Swallowing Function: A Systematic Review

Characteristics of Globus Pallidus Internus Local Field Potentials in Hyperkinetic Disease

Long-term Efficacy of GPi DBS for Cranio Facial Dystonia: a Retrospective Report of 13 Cases

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