The first symptom often starts with a slight tremor of the orbicularis oculi muscle of the lower eyelid, and gradually extends upward to all the orbicularis oculi muscle, and then to the lower half of the facial muscle, especially the corner of the mouth twitches more often. In severe cases, the whole facial muscles and the ipsilateral broad neck muscles can spasm, and when the orbicularis oculi muscle is in severe spasm, the eyes cannot be opened, thus affecting walking and work, and may be accompanied by mild weakness and muscle atrophy. The spasm may be aggravated by mental stress, fatigue and voluntary movement, and disappears during sleep. Facial muscle twitches are not accompanied by pain, and the random contraction of facial muscle is generally unaffected during non-facial muscle twitches. Bilateral eyelid twitching and occasional involuntary lip twitching are not easily diagnosed as facial muscle twitching, and often need to be differentiated from dystonia, i.e. Meige syndrome. Meige syndrome (MS), also known as Meige/Meige syndrome, is a form of localized dystonia first described by French neurologist Henry Meige in 1910, mainly causing eyelid spasms and various forms of dystonia of the low face, jaw and neck, and is an adult onset facial dystonia disorder. Primary Major syndrome, with symptoms usually occurring in the 50s or 60s and a significantly higher incidence in women than in men, with a male:female ratio of about 1:2 to 3, is a form of focal dystonia characterized by eyelid spasms and non-random movements of the lower face, jaw, and neck that can lead to disability. Blepharospasm can impair a patient’s ability to read, drive a motor vehicle, or write, and in the most severe cases can cause functional blindness. It mainly affects the facial muscles and with the progression of symptoms may develop spastic dysphonia, dystonia of the neck, trunk, and extremities, and difficulty in eating and swallowing. Dystonic disorders are clinical syndromes with very complex etiologies. The etiology and pathophysiological mechanisms of primary Meige syndrome are still unclear. Research by national and international scientists suggests that dopaminergic, cholinergic, and gamma-aminobutyric acid neuronal dysfunction in the thalamic nuclei and basal ganglia of the brain leads to neurotransmitter imbalance, causing deficits in the excitatory and inhibitory pathways of control, and ultimately to a failure in the integration of interactive muscle activity and spontaneous motor control, which ultimately causes the symptoms of Meige syndrome. The age and sex of onset differ significantly from primary torsional spasm, but most investigators consider it a variant of primary torsional spasm; the current study shows that Meige syndrome is closely related to the cortico-striato-pallidum-thalamus loop that is linked to the basal ganglia. Treatment of Meige’s syndrome currently consists of three main modalities: (1). Medication Medication currently available includes some dopaminomimetic, antidopaminic, anticholinergic, monoamine oxidase inhibitors, barbiturates, benzodiazepines, carbamazepine, etc., but with limited efficacy; recently it has been reported that levetiracetam has some therapeutic effect on Meige syndrome; also botulinum toxin injection can play a transient role in eyelid and mandibular dystonia However, its use has been limited due to significant side effects (2). Botulinum toxin injections are temporary and limited for the treatment of oral and facial dystonia, especially for low facial dystonia. (3) Neurosurgical treatment The main neurosurgical treatment methods are stereotactic deep brain nucleus destruction and deep brain stimulation (DBS). Since Benabid et al. first applied DBS to treat movement disorders in 1987, DBS has been rapidly developed in the neurosurgical treatment of movement disorders [11,12]. In recent years, clinical studies on the application of bilateral Globus Pallidus Internas (GPi) DBS for the treatment of motor symptoms and dysfunction caused by primary generalized or partial dystonia have achieved better results. At present, there is no better method for the treatment of drug-refractory primary Meige syndrome. In recent years, many scholars have started to try to treat Meige syndrome with DBS. The diagnosis of primary Meige syndrome is clear, and after at least two to three different kinds of drug treatment, the drug treatment is ineffective or the drug produces obvious side effects. 2. Progressive development of the disease, the duration of the disease is more than 1 to 2 years. 3. The disease affects work, study and life, and the patient is less than 75 years old and has good cooperation ability. 4. No pathological signs and declining changes in the nervous system. No serious psychiatric disorders. 5. Able to correctly understand the efficacy and complications of surgery and able to accept them. 6. Good social environment, marital status, self-confidence and ability to cooperate. Have reasonable expectation of the efficacy of DBS surgery. (B) Contraindications 1. Severe cardiac, hepatic, renal, diabetic and hypertensive cerebral arteriosclerosis. 2. Abnormal coagulation mechanism and application of anti-platelet coagulation drugs. 3. Those with significant intellectual impairment or psychiatric symptoms. 4. Severe cerebral atrophy or other intracerebral organic lesions. 5. Those who cannot cooperate with postoperative program control and those who cannot accept implants. 6. Those with severe cardiopulmonary disease and uncontrollable intractable hypertension, etc. 7. Those who are over 75 years old and in poor general condition and cannot tolerate surgery. Preoperative preparation 1. Preoperative laboratory tests and neuroimaging are routinely performed. 2. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to score the severity of dystonia before surgery. 3. Pre-operative psychiatric and psychological assessment including Yale-Brown obsessive-compulsive rating scale, Hamilton depression rating scale (HAMD) score. 4. 4. For patients who cannot control head, face and neck twitching, preoperative cranial MRI positioning scan sequence can be performed under drug sedation, and the surgical planning system is used for surgical planning design to reduce the scanning time on the surgical day. Intraoperative and postoperative precautions 1. The operator should have a good understanding of the functions of the DBS machine and skilled operating skills, strictly abide by the surgical operation routine and pay attention to aseptic operation. 2. Strictly control the blood pressure during the operation, closely observe the patient’s pulse, respiration and oxygen saturation, pay attention to hemostasis during the operation, minimize the cerebrospinal fluid loss, and reduce the target displacement caused by brain tissue displacement, which affects the postoperative efficacy. 3. During the electrode implantation, do the verification of the target point, and the accuracy of the target point placement can be checked intraoperatively after the electrode implantation. 4. After surgery, re-examine cranial CT or MRI to clarify the accuracy of electrode implantation and exclude asymptomatic intracranial hemorrhage, and routinely give prophylactic anti-infection and anti-epileptic treatment and prevent brain edema by dehydration if necessary. 5. Patients should be advised to get out of bed as soon as possible after surgery and perform functional exercises to prevent secondary pulmonary infections and deep vein thrombosis of the lower limbs. 6. Patients with DBS implantation should avoid strenuous exercise as much as possible after surgery, and their daily life is basically unaffected. Most household appliances do not affect the function of the IPG, but the following points should be noted: ① heat therapy should not be directed at the IPG implantation site. ②Radiation therapy should not be directed to the IPG implantation site. ③Intraoperative surgical electrocoagulation should not be operated near the IPG and connection line, and surgical electrocoagulation should be used sparingly or not at all. ④Patients with DBS implants should avoid entering and leaving areas with strong magnetic fields, and if necessary (e.g., for MRI examinations, the IPG can be temporarily closed). ⑤ Anti-theft devices and airport security checks can affect the output of the IPG and the patient’s stimulation function. In this case, the patient can show the relevant proof and take the security channel. 7. Stimulation parameters setting and adjustment In principle, the best time to adjust the stimulation parameters is between the 2nd and 4th week after surgery, in order to reduce the pseudo-effect of mechanical destruction of the GPi nucleus or STN nucleus during the electrode implantation. Stimulation parameters include: DBS electrode contact selection, polarity selection of contacts, amplitude (voltage), pulse width, frequency and other indicators. The range of stimulation parameters selected by comprehensive domestic and foreign authors for MS are frequency 130-160 Hz, pulse width 90-120 μsec, and voltage 2-4 V. Each time parameter adjustment is performed, the electrical impedance needs to be checked, and changes in symptoms are usually finalized several hours or even days after the parameter setting is completed, and the stimulation parameters are recorded after they are set, and both the patient and the programmer After the stimulation parameters are set, they should be recorded and kept by both the patient and the programmer. Intracranial hemorrhage occurs intraoperatively or postoperatively, most of the hemorrhage is in the channel of the implantation pathway, and a few can also occur in the subarachnoid space, mostly because the blood vessels on the surface of the brain are damaged during the puncture process, so when choosing the puncture implantation pathway, we should try to pass through the cerebral gyrus and avoid passing through the cerebral sulcus. The location of the cranial puncture site can be selected through the surgical planning system, avoiding the cerebral sulcus and important vascular alignment area on imaging, and controlling the mean arterial pressure within 95 mmHg intraoperatively. 2.Intracranial infection Postoperative antibiotics are routinely applied to prevent infection. To avoid the above complications, the dural incision should be reduced as much as possible and the bone hole should be filled with cotton to reduce the loss of cerebrospinal fluid. If there is excessive cerebrospinal fluid loss during the operation, appropriate amount of warm saline can be injected into the cranium when the skull is closed, and after the operation, the patient can adopt a slightly higher head position to avoid cerebrospinal fluid outflow. 4. Electrode fracture and displacement, pulse generator failure Apply titanium plate connecting piece or electrode wire fixation device to fix the intracranial electrode to reduce the chance of intracranial electrode displacement, if the electrode is short-circuited or disconnected, the electrode should be reconnected or replaced. 5. Foreign body rejection In case of severe implant rejection, the DBS device should be completely removed. 6. cerebrospinal fluid leakage and subcutaneous fluid collection Intraoperatively, the dura mater and all layers of the scalp are tightly sutured and the penetration tunnel is reinforced. For patients with thin subclavian skin, the site of the buried IPG can be changed to the abdomen to reduce the strength and frequency of its friction with the outside world. VI. Results Combined with the current clinical data from several neurosurgery centers at home and abroad, the clinical efficacy statistics of deep brain electrical stimulation surgery for Meijer syndrome show that this surgical method has the advantages of safety, high efficiency, few complications, and is adjustable and reversible, and GPi-DBS can not only greatly improve the eyelid spasm, lip and mouth, involuntary jaw movement symptoms of patients with Meijer syndrome and The GPi-DBS not only greatly improved the blepharospasm, lip and jaw involuntary movement symptoms and speech and swallowing functions in patients with Major syndrome, but also improved the patient’s cervical and generalized dystonia, with significant improvements in BFMRS-I (motor score) and BFMRS-II (disability score) scores. In patients treated with this method by foreign physicians such as Loher et al, the improvement in eye and mouth dystonia reached 92% and 75%, respectively, at 7 years of follow-up after surgery.