Clinical Analysis And Comparison Of The Treatment Of Meige Syndrome By Deep Brain Stimulation With Different Targets

Background:Meige syndrome,also known as idiopathic blepharospasm-oromandibular dystonia syndrome,is a manifestation of segmental dystonia.First described in 1910 by the French physician Henry Meige.There are three main types:blepharospasm,oromandibular dystonia and blepharospasm with oromandibular dystonia.It is generally believed that the third type is the complete type of major syndrome,while the first two types are incomplete.The patient mainly presents with involuntary bilateral eyelid tonic contraction or clonus,with or without spasm of oropharyngeal and mandibular muscles.It has a large disability,which seriously affects the quality of life of patients.The conservative treatment is mainly medication.However,with the progressive aggravation of the disease,the adverse reaction of the drug gradually aggravates with the increase of the drug dose,and the patient is often difficult to tolerate.Another treatment is injections of botox.However,as the body produces antibodies against botox,the effectiveness of this treatment diminishes.Surgical treatment mainly includes deep brain mass destruction and deep brain stimulation.With the development of stereotactic neurosurgery,deep brain stimulation(DBS)is increasingly used in the treatment of Meige syndrome.Its advantages in the treatment of Meige syndrome gradually showed up and became an important method for the treatment of Meige syndrome.DBS has been recognized as the most effective intervention for intractable systemic,segmental,and focal dystonia.Clinical use of DBS in the treatment of dystonia mainly USES the subthalamic nucleus(STN)and the medial pallidum(GPi).However,the neurosurgical community has not yet concluded whether DBS can improve the efficacy and safety of Meige syndrome,whether there is any difference in the efficacy of the two targets of the subthalamic nucleus(STN)and the medial pallidum(GPi),and whether it can predict the prognosis of patients.Objective:In order to further explore the DBS surgery in the treatment effect and safety of Meige syndrome,subthalamic nuclei(STN)or the medial globus pallidus(GPi)electrical stimulation effect of the two targets are there any differences and predict patient surgery effect factors,we involved in the project,through the line of DBS treatment for shandong provincial hospital Meige syndrome were analyzed retrospectively,to explore the patients before and after the surgery and BFMDRS score differences between different stimulation target to explore these issues,This study provides a theoretical basis for clinicians to further understand the disease,surgical indications and the effect of deep brain stimulation on the prognosis of Meige syndrome.Methods:A retrospective review was made of 9 patients with Meige syndrome treated by subthalamic nucleus-deep brain stimulation and medial pallidum-deep brain stimulation in our department from September 2016 to December 2018.According to the BFM dystonia rating scale of GPi and the STN,respectively,using the two targets for electrical stimulation of Meige syndrome before and after surgery for patients with kinematics and living ability score,statistical analysis and comparison of different targets for Meige syndrome symptoms improve the similarities and differences,to assess differences in the efficacy of two targets and summarize corresponding surgical indication to guide clinical practice.Results:None of the 9 patients had serious complications.The symptoms of patients after DBS were significantly improved compared with those before DBS.The average preoperative BFM score was 19.11±5.06.At the first follow-up,the average BFM score was 8.67±3.43,and the average improvement rate was 55.49±9.21%.At the last follow-up,the BFM score was 5.11±2.67.The average improvement rate was 73.95±9.05%.The differences in BFMDRS scores before and after surgery were statistically significant.At the same time,BFMDRS score decreased gradually with the extension of stimulus time,showing an overall downward trend.There was no statistically significant difference in the mean improvement rate of BFM score between the STN group and the GPi group.Conclusion:Stereotactic deep brain stimulation(DBS)is a safe and effective method to treat Meige syndrome.Deep brain stimulation targeting STN and GPi can improve the symptoms of patients with Meige syndrome to varying degrees.The improvement of symptoms was observed at the early stage after the operation,but there was no significant difference in the long-term effect.Gender,disease course and age of onset cannot be used as prognostic factors for DBS,but more studies are needed to confirm.