Putaminal-cortical circuits predict response of bilateral deep brain stimulation of the subthalamic nucleus in the primary Meige syndrome after 5 years

The deep brain stimulation (DBS) in the subthalamic nucleus (STN) has attracted more attention for primary Meige syndrome due to easier target location and lower power consumption. However, potential and reliable preoperative predictors of longitudinal outcomes of STN-DBS to guide therapeutic decisions remain largely unexplored. Herein, we used preoperative structural MRI and Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) from 55 patients with primary Meige syndrome who finished STN-DBS after 5 years. They were further classified into response (<i>n</i> = 23) and super-response (<i>n</i> = 32) based on the improvement rates of BFMDRS. Voxel-based morphology, partial correlation analyses, receiver operating characteristic (ROC) analyses and support vector machine were performed. We identified that improved rates of BFMDRS were 63, 71.97, 76.64, 79.51, 81.02, 81.36, 81.16, 80.80 and 80.93% at 1, 3, 6, 12, 18, 24, 36, 48 and 60 months after STN-DBS, respectively, and remained steady across 1-5 years. Further voxel-based morphology analyses revealed significantly lower grey-matter volume in the right hippocampus, left putamen, right supramarginal gyrus and left superior frontal gyrus in response when compared with super-response. The grey-matter volumes in the left putamen, right supramarginal gyrus and left superior frontal gyrus were not only positively correlated with improvement rates of BFMDRS after STN-DBS for 5 years in the primary Meige syndrome, but also presented a reliable classification ability in distinguishing response and super-response (area under curve = 0.855). These results suggested that STN-DBS is an effective treatment for primary Meige syndrome, and preoperative grey-matter volume of putaminal-cortical circuits could be used as potential biomarkers to predict longitudinal outcomes.