Stimulation-Induced Dyskinesia After Subthalamic Nucleus Deep Brain Stimulation in Patients With Meige Syndrome

Ning Wang; Kailiang Wang; Qiao Wang; Shiying Fan; Zonghui Fu; Feng Zhang; Lin Wang; Fangang Meng

doi:10.1111/ner.13284

Stimulation-Induced Dyskinesia After Subthalamic Nucleus Deep Brain Stimulation in Patients With Meige Syndrome

Neuromodulation. 2021 Feb;24(2):286-292. doi: 10.1111/ner.13284. Epub 2020 Sep 22.

Authors

Ning Wang^{1

2}, Kailiang Wang^{1

2}, Qiao Wang^{1

2}, Shiying Fan^{1

2}, Zonghui Fu³, Feng Zhang², Lin Wang³, Fangang Meng^{1

4}

Affiliations

¹ Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
² Beijing Key Laboratory of Neurostimulation, Beijing, China.
³ Department of Functional Neurosurgery, Aviation General Hospital, Beijing, China.
⁴ Department of Neurosurgery, The First Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.

PMID: 32964635
DOI: 10.1111/ner.13284

Abstract

Objectives: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is increasingly used to treat Meige syndrome (MS) and markedly improves symptoms. Stimulation-induced dyskinesia (SID), which adversely affects surgical outcomes and patient satisfaction, may, however, occur in some patients. This study attempts to explore possible causes of SID.

Materials and methods: Retrospectively collected clinical data on 32 patients who underwent STN-DBS between October 2016 and April 2019 were analyzed. Clinical outcomes were assessed pre- and post-surgery, using the Burke-Fahn-Marsden dystonia rating scale (BFMDRS). Patients were divided into a dyskinesia group and a non-dyskinesia group, according to whether or not they experienced persistent SID during follow-up. The coordinates of the active contacts were calculated from post-operative computerized tomography or magnetic resonance imaging, using the inter-commissural line as a reference. At final follow-up, the main stimulatory parameters for further study included pulse width, voltage, and frequency.

Results: At final follow-up (mean = 16.3 ± 7.2 months), MS patients had improved BFMDRS total scores compared with pre-surgical scores (mean improvement = 79.0%, p < 0.0001). The mean improvement in BFMDRS total scores in the dyskinesia (n = 10) and non-dyskinesia (n = 22) groups were 81.6 ± 8.8% and 77.9 ± 14.2%, respectively. The mean minimum voltage to induce dyskinesia was 1.7 ± 0.3 V. The programmed parameters of both groups were similar. When compared with the non-dyskinesia group, active stimulatory contact coordinates in the dyskinesia group were inferior (mean left side: z = -2.3 ± 1.7 mm vs. z = -1.2 ± 1.5 mm; p = 0.0282; mean right side: z = -2.7 ± 1.9 mm vs. z = -2.3 ± 1.7 mm; p = 0.0256). The x and y coordinates were similar.

Conclusion: STN-DBS is an effective intervention for MS, providing marked improvements in clinical symptoms; SID may, however occur in the subsequent programming control process. Comparing patients with/without dyskinesia, the active contacts were located closer to the inferior part of the STN in patients with dyskinesia, which may provide an explanation for the dyskinesia.

Keywords: Deep brain stimulation; Meige syndrome; dyskinesia; subthalamic nucleus.

MeSH terms

Deep Brain Stimulation*
Dyskinesias* / diagnostic imaging
Dyskinesias* / etiology
Dyskinesias* / therapy
Humans
Meige Syndrome* / therapy
Retrospective Studies
Subthalamic Nucleus*
Treatment Outcome