Idiopathic delayed-onset edema surrounding deep brain stimulation leads

Insights from a case series and systematic literature review

Catherine M K E de Cuba, Alberto Albanese, Angelo Antonini, Giovanni Cossu, Günther Deuschl, Roberto Eleopra, Alejandro Galati, Carel F E Hoffmann, Karina Knudsen, Andrea Landi, M. Lanotte, Andrea Marcante, Arne Mosch, Manuela Pilleri, Martin M. Reich, Valeria Ricchi, Sara Rinaldo, Luigi Michele Romito, Felipe S. Saba, Horacio E. Sacristan & 6 others P. Richard Schuurman, A. Trezza, Pepijn van den Munckhof, Jens Volkmann, Maurizio Zibetti, M. F. Contarino

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)108-115
Number of pages8
JournalParkinsonism and Related Disorders
Volume32
DOIs
Publication statusPublished - Nov 1 2016

Fingerprint

Deep Brain Stimulation
Edema
Blood Vessels
Anti-Bacterial Agents
Unnecessary Procedures
Delayed Diagnosis
Infection
Reoperation
PubMed
Causality
Psychiatry
Seizures
Wounds and Injuries

Keywords

  • Complications
  • Deep brain stimulation
  • Delayed onset
  • Edema

ASJC Scopus subject areas

  • Neurology
  • Geriatrics and Gerontology
  • Clinical Neurology

Cite this

Idiopathic delayed-onset edema surrounding deep brain stimulation leads : Insights from a case series and systematic literature review. / de Cuba, Catherine M K E; Albanese, Alberto; Antonini, Angelo; Cossu, Giovanni; Deuschl, Günther; Eleopra, Roberto; Galati, Alejandro; Hoffmann, Carel F E; Knudsen, Karina; Landi, Andrea; Lanotte, M.; Marcante, Andrea; Mosch, Arne; Pilleri, Manuela; Reich, Martin M.; Ricchi, Valeria; Rinaldo, Sara; Romito, Luigi Michele; Saba, Felipe S.; Sacristan, Horacio E.; Schuurman, P. Richard; Trezza, A.; van den Munckhof, Pepijn; Volkmann, Jens; Zibetti, Maurizio; Contarino, M. F.

In: Parkinsonism and Related Disorders, Vol. 32, 01.11.2016, p. 108-115.

Research output: Contribution to journalArticle

de Cuba, CMKE, Albanese, A, Antonini, A, Cossu, G, Deuschl, G, Eleopra, R, Galati, A, Hoffmann, CFE, Knudsen, K, Landi, A, Lanotte, M, Marcante, A, Mosch, A, Pilleri, M, Reich, MM, Ricchi, V, Rinaldo, S, Romito, LM, Saba, FS, Sacristan, HE, Schuurman, PR, Trezza, A, van den Munckhof, P, Volkmann, J, Zibetti, M & Contarino, MF 2016, 'Idiopathic delayed-onset edema surrounding deep brain stimulation leads: Insights from a case series and systematic literature review', Parkinsonism and Related Disorders, vol. 32, pp. 108-115. https://doi.org/10.1016/j.parkreldis.2016.09.007
de Cuba, Catherine M K E ; Albanese, Alberto ; Antonini, Angelo ; Cossu, Giovanni ; Deuschl, Günther ; Eleopra, Roberto ; Galati, Alejandro ; Hoffmann, Carel F E ; Knudsen, Karina ; Landi, Andrea ; Lanotte, M. ; Marcante, Andrea ; Mosch, Arne ; Pilleri, Manuela ; Reich, Martin M. ; Ricchi, Valeria ; Rinaldo, Sara ; Romito, Luigi Michele ; Saba, Felipe S. ; Sacristan, Horacio E. ; Schuurman, P. Richard ; Trezza, A. ; van den Munckhof, Pepijn ; Volkmann, Jens ; Zibetti, Maurizio ; Contarino, M. F. / Idiopathic delayed-onset edema surrounding deep brain stimulation leads : Insights from a case series and systematic literature review. In: Parkinsonism and Related Disorders. 2016 ; Vol. 32. pp. 108-115.
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abstract = "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.",
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T2 - Insights from a case series and systematic literature review

AU - de Cuba, Catherine M K E

AU - Albanese, Alberto

AU - Antonini, Angelo

AU - Cossu, Giovanni

AU - Deuschl, Günther

AU - Eleopra, Roberto

AU - Galati, Alejandro

AU - Hoffmann, Carel F E

AU - Knudsen, Karina

AU - Landi, Andrea

AU - Lanotte, M.

AU - Marcante, Andrea

AU - Mosch, Arne

AU - Pilleri, Manuela

AU - Reich, Martin M.

AU - Ricchi, Valeria

AU - Rinaldo, Sara

AU - Romito, Luigi Michele

AU - Saba, Felipe S.

AU - Sacristan, Horacio E.

AU - Schuurman, P. Richard

AU - Trezza, A.

AU - van den Munckhof, Pepijn

AU - Volkmann, Jens

AU - Zibetti, Maurizio

AU - Contarino, M. F.

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N2 - 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.

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KW - Delayed onset

KW - Edema

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