Clinical analysis of balance and gait disorders after subthalamic nucleus deep brain stimulation in patients with Meige's syndrome

Abstract

Objective To summarize and analyze the data of postural balance and gait disorders in patients with Meige's syndrome (MS) who underwent subthalamic nucleus deep brain stimulation (STN ⁃ DBS). Methods The study included 14 patients with MS who underwent bilateral STN⁃DBS surgery from July 2015 to September 2019 and developed postural balance and gait disorders. Burke⁃Fahn⁃ Marsden Dystonia Rating Scale (BFMDRS) and Tinetti Balance and Gait Analysis (TBGA) were used to assess the degrees of dystonia and balance, and gait disorders at the time of preoperative and final follow ⁃ up, respectively. Results The STN⁃DBS stimulation mode was unipolar in all 14 patients, and all showed some degrees of postural balance and gait disorders. The mean follow⁃up time was (28.36 ± 9.52) months. At the last follow⁃up, the overall improvement in BFMDRS score was (79.57 ± 22.21)%, among which the improvement rate of the motor score was (78.68 ± 19.91)% and the dysfunction score was (72.99 ± 46.54)%. The total score of BFMDRS (Z = ⁃ 4.055, P = 0.000) and the motor score (Z = ⁃ 3.919, P = 0.000) were lower than those before operation. The deterioration rate of TBGA was (28.61 ± 9.66)% , including of balance score (22.05 ± 10.32)% and gait score (37.39 ± 9.79)%. Total TBGA score (Z = ⁃ 4.658, P = 0.000), balance score (Z = ⁃ 3.325, P = 0.001) and gait score (Z = ⁃ 3.324, P = 0.001) were all lower than those before operation. By adjusting program⁃controlled parameters or changing stimulation contacts during the follow⁃up period, balance and gait disorder were improved obviously in 6 patients, however, 8 patients' symptoms were not improved well. Conclusions Patients with MS may experience a certain percentage of balance and gait disorders after treatment with STN⁃DBS. By adjusting the stimulation contact and changing the program⁃controlled parameters, it is only effective for some patients. Whether the other stimulation modes (bipolar stimulation, frequency conversion stimulation, cyclic stimulation, etc.) are effective or not remains to be studied.

DOI：10.3969/j.issn.1672⁃6731.2020.12.007