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.
Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité-Universitätsmedizin, Berlin, Germany.
Parkinsonism Relat Disord. 2019 Jan;58:40-45. doi: 10.1016/j.parkreldis.2018.05.014. Epub 2018 Jul 10.
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.
This study explored the relationship of electrode contact location in bilateral STN-DBS with clinical efficacy in Meige syndrome patients through retrospective analysis.
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.
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).
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.
丘脑底核（STN）脑深部电刺激（DBS）最近已被证明是治疗梅杰综合征的有效方法，但症状改善的效果及其与 DBS 因素的关系仍有待探索。
通过回顾性分析，探讨双侧 STN-DBS 中电极接触位置与梅杰综合征患者临床疗效的关系。
对梅杰综合征患者（n=15）的术前和术后磁共振（MR）图像进行分析。采用 Burke-Fahn-Marsden 肌张力障碍量表（BFMDRS）评估临床疗效。确定 Montreal Neurological Institute（MNI）标准空间中活动触点的位置和激活 STN 组织的体积，并与临床疗效相关。
在最后一次随访时（平均=14.8±4.0 个月；范围=11-24 个月），与术前评估相比，梅杰综合征患者（n=14）的 BFMDRS 评分显著改善（平均改善率=70.9%，p=0.001）。刺激的活动触点位于 MNI 空间的坐标（左侧平均值：x=-12.5±1.2mm，y=-13.3±1.7mm，z=-5.5±2.5mm；右侧平均值：x=12.7±1.4mm，y=-12.7±1.7mm，z=-6.4±2.4mm），主要集中在 STN 的背外侧。虽然根据症状改善程度（<30%、30-70%和>70%）将患者分组时，其各自的坐标没有显著差异，但 STN 内激活组织的体积与 BFMDRS 的改善显著相关（R=0.6，p=0.02）。
这些发现进一步支持刺激 STN 背外侧以有效缓解梅杰综合征患者的症状，并表明 DBS 的特定因素可用于预测临床疗效。
