Meige Syndrome Relieved by Bilateral Pallidal Stimulation with Cycling Mode
BACKGROUND AND IMPORTANCE: Deep brain stimulation (DBS) of bilateral globus pallidus internus (GPi) has been used effectively in the treatment of dystonia. We report a patient with severe Meige syndrome who received bilateral GPi DBS with good improvement in symptoms during the first 24-month stimulation therapy. In order to decrease energy consumption and to prolong battery life, the stimulation parameters of the replaced programmable pulse generator (IPG) were adjusted to the cyclic mode in combination with the stimulator turned-off during night time sleep. The patient achieved similar good treatment effect with extended battery use duration in the following years.
CLINICAL PRESENTATION: A 66-year-old woman with a 3-year history of severe cranial-cervical dystonia received stereotaxic surgery for bilateral GPi DBS therapy. The Fahn-Marsden (BFM) dystonia score improved from 32 to 7.5. The effect lasted up to 24 months after therapy when the battery ran out of life. After careful evaluation, we adjusted the stimulation parameters of the second implantable pulse generator to cyclic stimulation mode and programmed the stimulator to turn-off automatically during night time sleep. The patient shows persistent good effect 36-months after starting use of the second IPG.
CONCLUSION: To treat dystonic symptoms effectively, stimulation parameters with higher energy consumption are usually required. For reducing the discomfort of repeated battery replacement within a short time and decreasing energy consumption in IPG, cyclic mode stimulation could be considered in dystonic patients receiving bilateral GPi DBS.