Rescue Subthalamic Deep Brain Stimulation for Refractory Meige Syndrome

2021 ◽  
pp. 1-3
Author(s):  
Veronica Tavares Aragão ◽  
Sara Carvalho Barbosa Casagrande ◽  
Clarice Listik ◽  
Manoel Jacobsen Teixeira ◽  
Egberto Reis Barbosa ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Botulinum Toxin A ◽  
Therapeutic Option ◽  
Somatotopic Organization ◽  
Meige Syndrome ◽  
Face Region ◽  
The Face ◽  
Short And Long Term ◽  
Deep Brain

Meige syndrome is a segmental form of dystonia. It is a disabling disease, especially when refractory to treatment with botulinum toxin. A well-established therapeutic option is deep brain stimulation (DBS), and the target in bilateral globus pallidus internus (GPi DBS) demonstrated satisfactory short- and long-term efficacy. However, some patients present minor or suboptimal responses after GPi DBS, and in those cases, rescue DBS may be appropriate. The present case illustrates a good outcome after subthalamic nucleus (STN) and not after GPi DBS (considering that both were well positioned and had adequate programming). The larger dimension of the GPi and its somatotopic organization, with the stimulation outside the “face region,” could explain our outcomes.

Pallidal deep brain stimulation in patients with cranial-cervical dystonia (Meige syndrome)

2007 ◽  
Vol 22 (13) ◽  
pp. 1885-1891 ◽  
Author(s):  
Jill L. Ostrem ◽  
William J. Marks ◽  
Monica M. Volz ◽  
Susan L. Heath ◽  
Philip A. Starr
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Cervical Dystonia ◽  
Meige Syndrome ◽  
Pallidal Deep Brain Stimulation ◽  
Deep Brain

scholarly journals Intestinal Levodopa/Carbidopa Infusion as a Therapeutic Option for Unresponsive Freezing of Gait after Deep Brain Stimulation in Parkinson’s Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Belén González-Herrero ◽  
Serge Jauma-Classen ◽  
Roser Gómez-Llopico ◽  
Gerard Plans ◽  
Matilde Calopa
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Therapeutic Option ◽  
Freezing Of Gait ◽  
Disease Rating ◽  
Deep Brain

Background. Treatment of freezing of gait (FOG) is always challenging because of its unpredictable nature and multifactorial physiopathology. Intestinal levodopa infusion has been proposed in recent years as a valuable option for its improvement. FOG in Parkinson’s disease (PD) can appear after deep brain stimulation in patients who never had gait symptoms. Objective. To study the effects of intestinal levodopa/carbidopa infusion in unresponsive-FOG that appears in PD patients treated with subthalamic nucleus deep brain stimulation. Methods. We retrospectively collected and analyzed demographic, clinical, and therapeutic data from five PD patients treated with subthalamic nucleus stimulation who developed unresponsive-FOG and received intestinal levodopa/carbidopa infusion as an alternative therapy. FOG was measured based on scores in item 14 of the Unified Parkinson’s Disease Rating Scale before and after intestinal levodopa infusion. Results. Administration of intestinal levodopa caused improvement of FOG in the “ON” state in four patients (80%) by 2 or more points in item 14 of the Unified Parkinson’s Disease Rating Scale. The improvement was maintained for at least 12 months. Conclusions. Intestinal levodopa infusion may be a valuable therapeutic option for unresponsive-FOG developed after subthalamic nucleus deep brain stimulation.

Pallidal deep brain stimulation in primary Meige syndrome: clinical outcomes and psychiatric features

2020 ◽  
Vol 91 (12) ◽  
pp. 1343-1348
Author(s):  
Qingpei Hao ◽  
Dongliang Wang ◽  
Jia OuYang ◽  
Hu Ding ◽  
Gaungyong Wu ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Sleep Quality ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Short Form ◽  
Depression Scale ◽  
Motor Symptoms ◽  
Meige Syndrome ◽  
Sf 36 ◽  
Deep Brain

ObjectivesTo study the efficacy and safety of bilateral globus pallidus internus deep brain stimulation (GPi-DBS) in refractory Meige syndrome (MS) and evaluate the psychiatric disorders before and after surgery.MethodsTwenty-two patients with MS treated with bilateral GPi-DBS were retrospectively analysed before surgery and after continuous neurostimulation. Before surgery, patients were assessed by the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), Self-Rating Depression Scale, Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36) and Pittsburgh Sleep Quality Index (PQSI), which corresponded to motor symptoms, depressive state, quality of life and sleep quality, respectively. The implantable pulse generator of each patient was activated at 1 month after surgery. At 1 month, 3 months, 6 months and 12 months after continuous neurostimulation, all patients were evaluated by the same scales above.ResultsThe BFMDRS movement scores decreased from 15.0±5.3 before surgery to 3.5±4.5 at 12 months after neurostimulation, with a mean improvement of 78% (p<0.001). The BFMDRS disability scores improved from 7.4±4.9 before surgery to 4.0±4.6 at 12 months after neurostimulation, with a mean improvement of 56% (p<0.001). The postoperative SF-36 scores had the remarkable improvement compared with baseline scores. Impaired sleep quality was found in 82% of patients and depression in 64% before surgery, which didn’t neither obtained amelioration after continuous neurostimulation.ConclusionsBilateral pallidal neurostimulation is a beneficial therapeutic option for refractory MS, which could improve the motor symptoms except for depression and sleep quality.

Predictive factors for long-term clinical outcomes of deep brain stimulation in the treatment of primary Meige syndrome

2020 ◽  
Vol 132 (5) ◽  
pp. 1367-1375 ◽  
Author(s):  
Xin Wang ◽  
Zhiqi Mao ◽  
Zhiqiang Cui ◽  
Xin Xu ◽  
Longsheng Pan ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Deep Brain Stimulation ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Brain Stimulation ◽  
Meige Syndrome ◽  
Outcome Group ◽  
Deep Brain

OBJECTIVEPrimary Meige syndrome is characterized by blepharospasm and orofacial–cervical dystonia. Deep brain stimulation (DBS) is recognized as an effective therapy for patients with this condition, but previous studies have focused on clinical effects. This study explored the predictors of clinical outcome in patients with Meige syndrome who underwent DBS.METHODSTwenty patients who underwent DBS targeting the bilateral subthalamic nucleus (STN) or globus pallidus internus (GPi) at the Chinese People’s Liberation Army General Hospital from August 2013 to February 2018 were enrolled in the study. Their clinical outcomes were evaluated using the Burke–Fahn–Marsden Dystonia Rating Scale at baseline and at the follow-up visits; patients were accordingly divided into a good-outcome group and a poor-outcome group. Putative influential factors, such as age and course of disease, were examined separately, and the factors that reached statistical significance were subjected to logistic regression analysis to identify predictors of clinical outcomes.RESULTSFour factors showed significant differences between the good- and poor-outcome groups: 1) the DBS target (STN vs GPi); 2) whether symptoms first appeared at multiple sites or at a single site; 3) the sub-item scores of the mouth at baseline; and 4) the follow-up period (p < 0.05). Binary logistic regression analysis revealed that initial involvement of multiple sites and the mouth score were the only significant predictors of clinical outcome.CONCLUSIONSThe severity of the disease in the initial stage and presurgical period was the only independent predictive factor of the clinical outcomes of DBS for the treatment of patients with Meige syndrome.

Pallidal deep brain stimulation in the treatment of Meige syndrome

2014 ◽  
Vol 48 (3) ◽  
pp. 196-199 ◽  
Author(s):  
Michał Sobstyl ◽  
Mirosław Ząbek ◽  
Zbigniew Mossakowski ◽  
Artur Zaczyński
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Meige Syndrome ◽  
Pallidal Deep Brain Stimulation ◽  
Deep Brain

Hypothalamic Deep Brain Stimulation for Cluster Headache: Experience From a New Multicase Series

Cephalalgia ◽  
2008 ◽  
Vol 28 (3) ◽  
pp. 285-295 ◽  
Author(s):  
T Bartsch ◽  
MO Pinsker ◽  
D Rasche ◽  
T Kinfe ◽  
F Hertel ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Brain Stimulation ◽  
Discharge Rate ◽  
Therapeutic Option ◽  
Case Series ◽  
Chronic Cluster Headache ◽  
Posterior Hypothalamus ◽  
Attack Frequency ◽  
Deep Brain

Deep brain stimulation (DBS) of the posterior hypothalamus was found to be effective in the treatment of drug-resistant chronic cluster headache. We report the results of a multicentre case series of six patients with chronic cluster headache in whom a DBS in the posterior hypothalamus was performed. Electrodes were implanted stereotactically in the ipsilateral posterior hypothalamus according to published coordinates 2 mm lateral, 3 mm posterior and 5 mm inferior referenced to the mid-AC-PC line. Microelectrode recordings at the target revealed single unit activity with a mean discharge rate of 17 Hz (range 13-35 Hz, n = 4). Out of six patients, four showed a profound decrease of their attack frequency and pain intensity on the visual analogue scale during the first 6 months. Of these, one patient was attack free for 6 months under neurostimulation before returning to the baseline which led to abortion of the DBS. Two patients had experienced only a marginal, non-significant decrease within the first weeks under neurostimulation before returning to their former attack frequency. After a mean follow-up of 17 months, three patients are almost completely attack free, whereas three patients can be considered as treatment failures. The stimulation was well tolerated and stimulation-related side-effects were not observed on long term. DBS of the posterior inferior hypothalamus is an effective therapeutic option in a subset of patients. Future controlled multi-centre trials will need to confirm this open-label experience and should help to better define predictive factors for non-responders.

Gamma Knife thalamotomy for tremor in the magnetic resonance imaging era

2013 ◽  
Vol 118 (4) ◽  
pp. 713-718 ◽  
Author(s):  
Ali Kooshkabadi ◽  
L. Dade Lunsford ◽  
Daniel Tonetti ◽  
John C. Flickinger ◽  
Douglas Kondziolka
Keyword(s):  
Deep Brain Stimulation ◽  
Gamma Knife ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Target Selection ◽  
The Elderly ◽  
Sensory Loss ◽  
The Face ◽  
The Mean ◽  
Deep Brain

Object The surgical management of disabling tremor has gained renewed vigor with the availability of deep brain stimulation. However, in the face of an aging population of patients with increasing surgical comorbidities, noninvasive approaches for tremor management are needed. The authors' purpose was to study the technique and results of stereotactic radiosurgery performed in the era of MRI targeting. Methods The authors evaluated outcomes in 86 patients (mean age 71 years; number of procedures 88) who underwent a unilateral Gamma Knife thalamotomy (GKT) for tremor during a 15-year period that spanned the era of MRI-based target selection (1996–2011). Symptoms were related to essential tremor in 48 patients (19 age ≥ 80 years and 3 age ≥ 90 years), Parkinson disease in 27 patients (11 age ≥ 80 years [1 patient underwent bilateral procedures]), and multiple sclerosis in 11 patients (1 patient underwent bilateral procedures). A single 4-mm isocenter was used to deliver a maximum dose of 140 Gy to the posterior-inferior region of the nucleus ventralis intermedius. The Fahn-Tolosa-Marin clinical tremor rating scale was used to grade tremor, handwriting, and ability to drink. The median follow-up was 23 months. Results The mean tremor score was 3.28 ± 0.79 before and 1.81 ± 1.15 after (p < 0.0001) GKT; the mean handwriting score was 2.78 ± 0.82 and 1.62 ± 1.04, respectively (p < 0.0001); and the mean drinking score was 3.14 ± 0.78 and 1.80 ± 1.15, respectively (p < 0.0001). After GKT, 57 patients (66%) showed improvement in all 3 scores, 11 patients (13%) in 2 scores, and 2 patients (2%) in just 1 score. In 16 patients (19%) there was a failure to improve in any score. Two patients developed a temporary contralateral hemiparesis, 1 patient noted dysphagia, and 1 sustained facial sensory loss. Conclusions Gamma Knife thalamotomy in the MRI era was a safe and effective noninvasive surgical strategy for medically refractory tremor in the elderly or those with contraindications to deep brain stimulation or stereotactic radiofrequency (thermal) thalamotomy.

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