Abstract
Meige syndrome (MS) is usually described as a combination of blepharospasm with oromandibular dystonia. There are a large number of case reports of deep brain stimulation (DBS) of the globus pallidus internus (GPI) for MS and only one report of unilateral pallidotomy (PT). We report the first case of staged bilateral PT for treatment of a patient with MS using intraoperative high-frequency stimulation in order to predict and prevent postoperative deficit. There was a significant improvement of the Burk-Fahn-Marsden dystonia rating scale from 26 to 3. There were no adverse postoperative neurological and neuropsychological events.
Similar content being viewed by others
References
Berman BD, Starr PA, Marks WJ Jr, Ostrem JL (2009) Induction of bradykinesia with pallidal deep brain stimulation in patients with cranial-cervical dystonia. Stereotact Funct Neurosurg 87:37–44
Blomstedt P, Tisch S, Hariz MI (2008) Pallidal deep brain stimulation in the treatment of Meige syndrome. Acta Neurol Scand 118:198–202
Capelle HH, Weigel R, Krauss JK (2003) Bilateral pallidal stimulation for blepharospasm-oromandibular dystonia (Meige syndrome). Neurology 60:2017–2018
Cersosimo MG, Raina GB, Piedimonte F, Antico J, Graff P, Micheli FE (2008) Pallidal surgery for the treatment of primary generalized dystonia: long-term follow-up. Clin Neurol Neurosurg 110:145–150
De Bie RM, Schuurman PR, Esselink RA, Bosch DA, Speelman JD (2002) Bilateral pallidotomy in Parkinson’s disease: a retrospective study. Mov Disord 17:533–538
Elkay M, Silver K, Penn RD, Dalvi A (2009) Dystonic storm due to Batten’s disease treated with pallidotomy and deep brain stimulation. Mov Disord 24:1048–1053
Foote KD, Sanchez JC, Okun MS (2005) Staged deep brain stimulation for refractory craniofacial dystonia with blepharospasm: case report and physiology. Neurosurgery 56:E415 discussion E415
Ghang JY, Lee MK, Jun SM, Ghang CG (2010) Outcome of pallidal deep brain stimulation in meige syndrome. J Korean Neurosurg Soc 48:134–138
Gross RE (2008) What happened to posteroventral pallidotomy for Parkinson’s disease and dystonia? Neurotherapeutics 5:281–293
Hebb MO, Chiasson P, Lang AE, Brownstone RM, Mendez I (2007) Sustained relief of dystonia following cessation of deep brain stimulation. Mov Disord 22:1958–1962
Houser M, Waltz T (2005) Meige syndrome and pallidal deep brain stimulation. Mov Disord 20:1203–1205
Inoue N, Nagahiro S, Kaji R, Goto S (2010) Long-term suppression of Meige syndrome after pallidal stimulation: a 10-year follow-up study. Mov Disord 25:1756–1758
Lin JJ, Lin SZ, Lin GY, Chang DC, Lee CC (1998) Application of bilateral sequential pallidotomy to treat a patient with generalized dystonia. Eur Neurol 40:108–110
Loher TJ, Capelle HH, Kaelin-Lang A, Weber S, Weigel R, Burgunder JM, Krauss JK (2008) Deep brain stimulation for dystonia: outcome at long-term follow-up. J Neurol 255:881–884
Lozano AM, Kumar R, Gross RE, Giladi N, Hutchison WD, Dostrovsky JO, Lang AE (1997) Globus pallidus internus pallidotomy for generalized dystonia. Mov Disord 12:865–870
Lyons MK, Birch BD, Hillman RA, Boucher OK, Evidente VG (2010) Long-term follow-up of deep brain stimulation for Meige syndrome. Neurosurg Focus 29:E5
Markaki E, Kefalopoulou Z, Georgiopoulos M, Paschali A, Constantoyannis C (2010) Meige’s syndrome: a cranial dystonia treated with bilateral pallidal deep brain stimulation. Clin Neurol Neurosurg 112:344–346
Marras CE, Rizzi M, Cantonetti L, Rebessi E, De Benedictis A, Portaluri F, Randi F, Savioli A, Castelli E, Vigevano F (2014) Pallidotomy for medically refractory status dystonicus in childhood. Dev Med Child Neurol 56:649–656
Muta D, Goto S, Nishikawa S, Hamasaki T, Ushio Y, Inoue N, Mita S (2001) Bilateral pallidal stimulation for idiopathic segmental axial dystonia advanced from Meige syndrome refractory to bilateral thalamotomy. Mov Disord 16:774–777
Ostrem JL, Marks WJ Jr, Volz MM, Heath SL, Starr PA (2007) Pallidal deep brain stimulation in patients with cranial-cervical dystonia (Meige syndrome). Mov Disord 22:1885–1891
Reese R, Gruber D, Schoenecker T, Bazner H, Blahak C, Capelle HH, Falk D, Herzog J, Pinsker MO, Schneider GH, Schrader C, Deuschl G, Mehdorn HM, Kupsch A, Volkmann J, Krauss JK (2011) Long-term clinical outcome in meige syndrome treated with internal pallidum deep brain stimulation. Mov Disord 26:691–698
Risch V, Staiger A, Ziegler W, Ott K, Scholderle T, Pelykh O, Botzel K (2015) How does GPi-DBS affect speech in primary dystonia? Brain Stimul 8:875–880
Romito LM, Elia AE, Franzini A, Bugiani O, Albanese A (2010) Low-voltage bilateral pallidal stimulation for severe meige syndrome in a patient with primary segmental dystonia: case report. Neurosurgery 67:onsE308 discussion onsE308
Sako W, Morigaki R, Mizobuchi Y, Tsuzuki T, Ima H, Ushio Y, Nagahiro S, Kaji R, Goto S (2011) Bilateral pallidal deep brain stimulation in primary Meige syndrome. Parkinsonism Relat Disord 17:123–125
Sensi M, Cavallo MA, Quatrale R, Sarubbo S, Biguzzi S, Lettieri C, Capone JG, Tugnoli V, Tola MR, Eleopra R (2009) Pallidal stimulation for segmental dystonia: long term follow up of 11 consecutive patients. Mov Disord 24:1829–1835
Sobstyl M, Zabek M, Mossakowski Z, Zaczynski A (2014) Pallidal deep brain stimulation in the treatment of Meige syndrome. Neurol Neurochir Pol 48:196–199
Tai CH, Wu RM, Liu HM, Tsai CW, Tseng SH (2011) Meige syndrome relieved by bilateral pallidal stimulation with cycling mode: case report. Neurosurgery 69:E1333–E1337
Turner KR, Reid WG, Homewood J, Cook RJ (2002) Neuropsychological sequelae of bilateral posteroventral pallidotomy. J Neurol Neurosurg Psychiatry 73:444–446
Valalik I, Jobbagy A, Bognar L, Csokay A (2011) Effectiveness of unilateral pallidotomy for meige syndrome confirmed by motion analysis. Stereotact Funct Neurosurg 89:157–161
Vercueil L, Pollak P, Fraix V, Caputo E, Moro E, Benazzouz A, Xie J, Koudsie A, Benabid AL (2001) Deep brain stimulation in the treatment of severe dystonia. J Neurol 248:695–700
Vitek JL, Zhang J, Evatt M, Mewes K, DeLong MR, Hashimoto T, Triche S, Bakay RA (1998) GPi pallidotomy for dystonia: clinical outcome and neuronal activity. Adv Neurol 78:211–219
Wang X, Zhang C, Wang Y, Liu C, Zhao B, Zhang JG, Hu W, Shao X, Zhang K (2015) Deep brain stimulation for Craniocervical dystonia (Meige syndrome): a report of four patients and a literature-based analysis of its treatment effects. Neuromodulation 19:818–823
Woehrle JC, Blahak C, Kekelia K, Capelle HH, Baezner H, Grips E, Weigel R, Krauss JK (2009) Chronic deep brain stimulation for segmental dystonia. Stereotact Funct Neurosurg 87:379–384
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Ethical approval
The patient has consented to submission of this case report to the journal.
Additional information
Comments
In this era of DBS hysteria, there are people who still believe in the benefit of non-expensive and well-performed stereotactic lesional procedures, and provide solid documentation about its benefit. This paper is one of them.
Marwan Hariz
London, UK
Electronic supplementary material
Preoperative video (MOV 43595 kb)
Postoperative video 3 days after left-sided PT (MOV 45170 kb)
Postoperative video 24 months after bilateral PT (MOV 43205 kb)
Rights and permissions
About this article
Cite this article
Minkin, K., Gabrovski, K., Dimova, P. et al. Bilateral pallidotomy for Meige syndrome. Acta Neurochir 159, 1359–1363 (2017). https://doi.org/10.1007/s00701-017-3178-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-017-3178-0