Idiopathic delayed-onset edema surrounding deep brain stimulation leads: Insights from a case series and systematic literature review.


INTRODUCTION Deep brain stimulation (DBS) is effective for some neurological and psychiatric conditions. Idiopathic delayed-onset edema (IDE) surrounding the leads has been anecdotally reported. The etiology, predisposing factors and prognosis of this complication are unknown. We present a multicenter case series of patients with IDE, and a systematic literature review, aimed at defining the pathophysiology and identifying appropriate treatment strategies. METHODS IDE was defined as edema along the DBS lead, occurring ≥72 h postoperatively, in absence of trauma, vascular events or infection. Information on patients with IDE was collected in a standardized way. A systematic search was performed in Pubmed. RESULTS Twelve new patients presenting with 14 episodes of IDE are described. From the literature, 38 patients were identified. No common surgical aspects or patient-related factors were identified as risk predictors for the onset of IDE. Symptoms included deterioration of the stimulation effect, seizures and focal neurological signs. Although the condition is self-limiting, with symptoms resolution in 28.5 days on average, three patients underwent surgical revision and seven received antibiotics. CONCLUSIONS IDE is a rare complication of DBS procedures, presenting from few days to months after surgery. Symptoms can be mild and not-specific, and the condition is self-limiting. The diagnosis of IDE is made after exclusion of vascular events or infections. The pathophysiology is still unexplained. The recognition of this complication can help avoiding unnecessary surgical procedures (system explantation) and antibiotic treatment.

DOI: 10.1016/j.parkreldis.2016.09.007

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@article{Cuba2016IdiopathicDE, title={Idiopathic delayed-onset edema surrounding deep brain stimulation leads: Insights from a case series and systematic literature review.}, author={Catherine M K E de Cuba and Alberto Albanese and Angelo Antonini and Giovanni A. Cossu and G{\"{u}nther Deuschl and Roberto Eleopra and Alejandro Galati and Carel F E Hoffmann and Karina Knudsen and Andrea Landi and Michele Maria R Lanotte and Andrea Marcante and Arne Mosch and Manuela Pilleri and Martin M. Reich and Valeria Ricchi and Sara Rinaldo and Luigi Michele Romito and Felipe S Saba and Horacio E Sacristan and Peter Schuurman and Andrea Trezza and Pepijn van den Munckhof and Jens Volkmann and Maurizio Zibetti and Maria Fiorella Contarino}, journal={Parkinsonism & related disorders}, year={2016}, volume={32}, pages={108-115} }