title: Meige syndrome relieved by bilateral pallidal stimulation with cycling mode:  case report.
abstract: BACKGROUND
  Deep brain stimulation (DBS) of the bilateral globus pallidus internus (GPi) has been used effectively to treat 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. To decrease energy consumption and to prolong battery life, the stimulation parameters of the replaced programmable pulse generator were adjusted to the cyclic mode and the stimulator was turned off during nighttime sleep. The patient achieved similar good treatment effect with extended battery life in the following years.
  
  
  METHODS
  A 66-year-old woman with a 3-year history of severe cranial-cervical dystonia received stereotaxic surgery for bilateral GPi DBS therapy. The Burke-Fahn-Marsden 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 the cyclic stimulation mode and programmed the stimulator to turn off automatically during nighttime sleep. The patient showed persistent good effect 36 months after starting use of the second implantable pulse generator.
  
  
  CONCLUSIONS
  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 implantable pulse generator, cyclic mode stimulation could be considered in dystonic patients receiving bilateral GPi DBS.
authors.affiliation: Department of Neurology, University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Chun-Hwei
authors.initials: CH
authors.lastname: Tai
authors.forename: Ruey-Meei
authors.initials: RM
authors.lastname: Wu
authors.forename: Hon-Man
authors.initials: HM
authors.lastname: Liu
authors.forename: Chia-Wen
authors.initials: CW
authors.lastname: Tsai
authors.forename: Sheng-Hong
authors.initials: SH
authors.lastname: Tseng
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D008538:Meige Syndrome / Q000628:therapy*