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Wu B, Liu J, Jiang L, Xu J, Xuan R, Ling Y, Guo Q, Jiang N, Chen L, Zhang C. Delayed-onset seizures after subthalamic nucleus deep brain stimulation surgery for Parkinson's disease. J Clin Neurosci 2024; 124:81-86. [PMID: 38669906 DOI: 10.1016/j.jocn.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/03/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Delayed-onset seizures after deep brain stimulation (DBS) surgery were seldom reported. This study summarized the clinical characteristics of delayed-onset seizures after subthalamic nucleus (STN) DBS surgery for Parkinson's disease (PD) and analyzed risk factors. METHODS A single-center retrospective study containing consecutive STN-DBS PD patients from 2006 to 2021 was performed. Seizures occurred during the DBS surgery or within one month after DBS surgery were identified based on routine clinical records. Patients with postoperative magnetic resonance imaging (MRI) were included to further analyze the risk factors for postoperative seizures with univariate and multivariate statistical methods. RESULTS 341 consecutive PD patients treated with bilateral STN-DBS surgery wereidentified, and five patients experienced seizures after DBS surgery with an incidence of 1.47 %. All seizures of the five cases were characterized as delayed onset with average 12 days post-operatively. All seizures presented as generalized tonic-clonic seizures and didn't recur after the first onset. In those seizures cases, peri-electrode edema was found in both hemispheres without hemorrhage and infarction. The average diameter of peri-electrode edema of patients with seizures was larger than those without seizures (3.15 ± 1.00 cm vs 1.57 ± 1.02 cm, p = 0.005). Multivariate risk factor analysis indicated that seizures were only associated with the diameter of peri-electrode edema (OR 4.144, 95 % CI 1.269-13.530, p = 0.019). CONCLUSIONS Delayed-onset seizures after STN-DBS surgery in PD patients were uncommon with an incidence of 1.47 % in this study. The seizures were transient and self-limiting, with no developing into chronic epilepsy. Peri-electrode edema was a risk factor for delayed-onset seizures after DBS surgery. Patients with an average peri-electrode edema diameter > 2.70 cm had a higher risk to develop seizures.
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Affiliation(s)
- Bin Wu
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China; Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China; Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai 200433, China
| | - Jinlong Liu
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Lulu Jiang
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Jiakun Xu
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Ruoheng Xuan
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Yuting Ling
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Qianqian Guo
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Nan Jiang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Ling Chen
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Changming Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
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Raguž M, Marčinković P, Chudy H, Orešković D, Lakić M, Dlaka D, Katavić N, Rački V, Vuletić V, Chudy D. Decreased brain volume may be associated with the occurrence of peri-lead edema in Parkinson's disease patients with deep brain stimulation. Parkinsonism Relat Disord 2024; 121:106030. [PMID: 38354427 DOI: 10.1016/j.parkreldis.2024.106030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/12/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Peri-lead edema (PLE) is a poorly understood complication of deep brain stimulation (DBS), which has been described in patients presenting occasionally with profound and often delayed symptoms with an incidence ranging from 0.4% up to even 100%. Therefore, our study aims to investigate the association of brain and brain compartment volumes on magnetic resonance imaging (MRI) with the occurrence of PLE in Parkinson's disease (PD) patients after DBS implantation in subthalamic nuclei (STN). METHODS This retrospective study included 125 consecutive PD patients who underwent STN DBS at the Department of Neurosurgery, Dubrava University Hospital from 2010 to 2022. Qualitative analysis was done on postoperative MRI T2-weighted sequence by two independent observers, marking PLE on midbrain, thalamus, and subcortical levels as mild, moderate, or severe. Quantitative volumetric analysis of brain and brain compartment volumes was conducted using an automated CIVET processing pipeline on preoperative MRI T1 MPRAGE sequences. In addition, observed PLE on individual hemispheres was delineated manually and measured using Analyze 14.0 software. RESULTS In our cohort, PLE was observed in 32.17%, mostly bilaterally. Mild PLE was observed in the majority of patients, regardless of the level observed. Age, sex, diabetes, hypertension, vascular disease, and the use of anticoagulant/antiplatelet therapy showed no significant association with the occurrence of PLE. Total grey matter volume showed a significant association with the PLE occurrence (r = -0.22, p = 0.04), as well as cortex volume (r = -0.32, p = 0.0005). Cortical volumes of hemispheres, overall hemisphere volumes, as well as hemisphere/total intracranial volume ratio showed significant association with the PLE occurrence. Furthermore, the volume of the cortex and total grey volume represent moderate indicators, while hemisphere volumes, cortical volumes of hemispheres, and hemisphere/total intracranial volume ratio represent mild to moderate indicators of possible PLE occurrence. CONCLUSION The results of our study suggest that the morphometric MRI measurements, as a useful tool, can provide relevant information about the structural status of the brain in patients with PD and represent moderate indicators of possible PLE occurrence. Identifying patients with greater brain atrophy, especially regarding grey matter before DBS implantation, will allow us to estimate the possible postoperative symptoms and intervene in a timely manner. Further studies are needed to confirm our findings and to investigate other potential predictors and risk factors of PLE occurrence.
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Affiliation(s)
- Marina Raguž
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; School of Medicine, Catholic University of Croatia, Zagreb, Croatia.
| | - Petar Marčinković
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Hana Chudy
- Department of Neurology, Dubrava University Hospital, Zagreb, Croatia
| | - Darko Orešković
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Marin Lakić
- Department of Neurosurgery, Dubrovnik General Hospital, Dubrovnik, Croatia
| | - Domagoj Dlaka
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Nataša Katavić
- Department of Radiology and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia
| | - Valentino Rački
- Department of Neurology, University Hospital Centre, Rijeka, Croatia
| | - Vladimira Vuletić
- Department of Neurology, University Hospital Centre, Rijeka, Croatia
| | - Darko Chudy
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; Department of Surgery, School of Medicine University of Zagreb, Zagreb, Croatia
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Wu B, Ling Y, Zhang C, Xu J, Yang C, Jiang N, Chen L, Liu J. Postoperative use of steroids for peri-electrode edema after deep brain stimulation surgery: A retrospective cohort study. CNS Neurosci Ther 2024; 30:e14470. [PMID: 37715573 PMCID: PMC10916416 DOI: 10.1111/cns.14470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/21/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND To review the incidence and extent of peri-electrode edema after DBS and to clarify the effect of postoperative use of steroids on the peri-electrode edema. METHODS This retrospective cohort study included 250 patients who underwent bilateral subthalamic nucleus (STN) DBS surgery with intact MRI within 1 month after DBS surgery. Patients were divided into steroid and non-steroid groups, based on postoperative steroids use. The occurrence and extent of peri-electrode edema were compared between the two groups, and other associated factors were analyzed using univariate and multivariate methods. RESULTS Peri-electrode edema >1 cm3 in at least one hemisphere was reported in 215 (86.00%) patients. The mean volume of peri-electrode edema observed in the steroid group was significantly smaller than in the non-steroid group (8.09 ± 8.47 cm3 vs 17.10 ± 16.90 cm3 , p < 0.001). In the steroid group, 104 (32.91%) of the 316 implanted electrodes present with edema less than 1 cm3 , whereas in the non-steroid group, only 27 (14.67%) of the 184 implanted electrodes present with edema less than 1 cm3 (p < 0.001). Multivariate analysis indicated that lesser peri-electrode edema was significantly associated with postoperative steroids use and general anesthesia. CONCLUSIONS Peri-electrode edema is common after DBS surgery, and postoperative steroids use reduces the occurrence and extent of peri-electrode edema.
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Affiliation(s)
- Bin Wu
- Department of Neurosurgery, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
- Department of Neurology, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yuting Ling
- Department of Anesthesiology, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Changming Zhang
- Department of Neurosurgery, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Jiakun Xu
- Department of Neurosurgery, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Chao Yang
- Department of Neurosurgery, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Nan Jiang
- Department of Anesthesiology, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Ling Chen
- Department of Neurology, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Jinlong Liu
- Department of Neurosurgery, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
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Girges C, Krüger MT, Xu SS, Akram H, Hyam J, Limousin P, Zrinzo L, Foltynie T. Brain Oedema Associated with Deep Brain Stimulation through a Single Directional Contact. Mov Disord Clin Pract 2023; 10:1695-1697. [PMID: 37982107 PMCID: PMC10654822 DOI: 10.1002/mdc3.13871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 11/21/2023] Open
Affiliation(s)
- Christine Girges
- Department of Clinical and Movement NeurosciencesUniversity College LondonLondonUK
- UCL Functional Neurosurgery UnitNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Marie T. Krüger
- Department of Clinical and Movement NeurosciencesUniversity College LondonLondonUK
- UCL Functional Neurosurgery UnitNational Hospital for Neurology and NeurosurgeryLondonUK
- Department of Neurosurgery, University Medical Centre Freiburg, Faculty of Medicine, University of FreiburgFreiburg im BreisgauGermany
| | - San San Xu
- Department of Clinical and Movement NeurosciencesUniversity College LondonLondonUK
- UCL Functional Neurosurgery UnitNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Harith Akram
- Department of Clinical and Movement NeurosciencesUniversity College LondonLondonUK
- UCL Functional Neurosurgery UnitNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Jonathan Hyam
- Department of Clinical and Movement NeurosciencesUniversity College LondonLondonUK
- UCL Functional Neurosurgery UnitNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Patricia Limousin
- Department of Clinical and Movement NeurosciencesUniversity College LondonLondonUK
- UCL Functional Neurosurgery UnitNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Ludvic Zrinzo
- Department of Clinical and Movement NeurosciencesUniversity College LondonLondonUK
- UCL Functional Neurosurgery UnitNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Thomas Foltynie
- Department of Clinical and Movement NeurosciencesUniversity College LondonLondonUK
- UCL Functional Neurosurgery UnitNational Hospital for Neurology and NeurosurgeryLondonUK
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Rodriguez N, Laurencin C, Klinger H, Simon E, Danaila T, Thobois S. Beware of atypical apathy after STN stimulation. Rev Neurol (Paris) 2022; 178:857-858. [PMID: 36153259 DOI: 10.1016/j.neurol.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/18/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- N Rodriguez
- Hospices civils de Lyon, hôpital neurologique Pierre Wertheimer, service de neurologie C, centre expert Parkinson, Bron, France
| | - C Laurencin
- Hospices civils de Lyon, hôpital neurologique Pierre Wertheimer, service de neurologie C, centre expert Parkinson, Bron, France
| | - H Klinger
- Hospices civils de Lyon, hôpital neurologique Pierre Wertheimer, service de neurologie C, centre expert Parkinson, Bron, France
| | - E Simon
- Hospices Civils de Lyon, hôpital Neurologique Pierre Wertheimer, service de neurochirurgie A, Bron, France
| | - T Danaila
- Hospices civils de Lyon, hôpital neurologique Pierre Wertheimer, service de neurologie C, centre expert Parkinson, Bron, France
| | - S Thobois
- Hospices civils de Lyon, hôpital neurologique Pierre Wertheimer, service de neurologie C, centre expert Parkinson, Bron, France; Université Claude Bernard Lyon 1, institut des sciences cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France; Université Claude Bernard Lyon 1, faculté de médecine et de Maïeutique Lyon Sud Charles Mérieux, Oullins, France.
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Fan H, Bai Y, Yin Z, An Q, Xu Y, Gao Y, Meng F, Zhang J. Which one is the superior target? A comparison and pooled analysis between posterior subthalamic area and ventral intermediate nucleus deep brain stimulation for essential tremor. CNS Neurosci Ther 2022; 28:1380-1392. [PMID: 35687507 PMCID: PMC9344089 DOI: 10.1111/cns.13878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/14/2022] [Accepted: 05/20/2022] [Indexed: 01/14/2023] Open
Abstract
Background/Aims The efficacy and safety of posterior subthalamic area (PSA) and ventral intermediate nucleus (VIM) deep brain stimulation (DBS) in the treatment of essential tremor (ET) have not been compared in large‐scale studies. We conducted a secondary analysis to identify the superior target of ET‐DBS treatment. Methods PubMed, Embase, Cochrane Library, and Google Scholar were searched for relevant studies before September 2021. The tremor‐suppression efficacy and rate of stimulation‐related complications (SRCR) after PSA‐DBS and VIM‐DBS treating ET were quantitatively compared. Secondary outcomes, including tremor subitem scores and quality of life results, were also analyzed. Subgroup analyses were further conducted to stratify by follow‐up (FU) periods and stimulation lateralities. This study was registered in Open Science Framework (DOI: 10.17605/OSF.IO/7VJQ8). Results A total of 23 studies including 122 PSA‐DBS patients and 326 VIM‐DBS patients were analyzed. The average follow‐up time was 12.81 and 14.66 months, respectively. For the percentage improvement of total tremor rating scale (TRS) scores, PSA‐DBS was significantly higher, when compared to VIM‐DBS in the sensitivity analysis (p = 0.030) and main analysis (p = 0.043). The SRCR after VIM‐DBS was higher than that of PSA‐DBS (p = 0.022), and bilateral PSA‐DBS was significantly superior to both bilateral and unilateral VIM‐DBS (p = 0.001). Conclusions This study provided level IIIa evidence that PSA‐DBS was more effective and safer for ET than VIM‐DBS in 12–24 months, although both PSA‐DBS and VIM‐DBS were effective in suppressing tremor in ET patients. Further prospective large‐scale randomized clinical trials are warranted in the future.
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Affiliation(s)
- Houyou Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yutong Bai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qi An
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yichen Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuan Gao
- Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Fangang Meng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
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