Reviving Hope: Overcoming Deep Brain Stimulation Failure With Partial Cranial Nerve Radiofrequency Ablation in Primary Meige Syndrome.

INTRODUCTION

Deep brain stimulation (DBS) is a standard treatment for refractory primary Meige syndrome (PMS), yet 30%-50% of patients experience suboptimal outcomes. Management strategies for these "DBS failures" remain undefined. This study evaluates the efficacy of partial cranial nerve radiofrequency ablation (RFA) as a salvage therapy for this challenging population.

METHODS

We report a retrospective series of three PMS patients classified as "DBS non-responders" based on clinical refractory status or ineligibility for lead revision. Patients underwent imaging-guided partial RFA of the facial nerve (for blepharospasm) and/or mandibular nerve (for oromandibular dystonia). The procedure utilized a graded thermal protocol, titrated strictly to a mild, controlled functional impairment clinical endpoints.

RESULTS

Immediate symptom remission was achieved in all cases. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) Movement subscores decreased significantly (e.g., from 9 to 0 in Case 1, and 14 to 0.5 in Case 2). Procedural sequelae, including mild facial paralysis and masticatory weakness, were transient and resolved within 3-6 months. One patient experienced symptom recurrence at 14 months, which was successfully managed via repeat RFA.

CONCLUSION

Partial cranial nerve RFA is a feasible, effective, and repeatable salvage therapy for PMS following DBS failure. By targeting the peripheral conduction pathway, it offers a distinct mechanism of action and a practical alternative when central neuromodulation proves insufficient. Future studies with larger cohorts are warranted to validate these preliminary findings.