Delayed-onset seizures after subthalamic nucleus deep brain stimulation surgery for Parkinson's disease

Bin Wu; Jinlong Liu; Lulu Jiang; Jiakun Xu; Ruoheng Xuan; Yuting Ling; Qianqian Guo; Nan Jiang; Ling Chen; Changming Zhang

doi:10.1016/j.jocn.2024.04.023

Delayed-onset seizures after subthalamic nucleus deep brain stimulation surgery for Parkinson's disease

J Clin Neurosci. 2024 Apr 25:124:81-86. doi: 10.1016/j.jocn.2024.04.023. Online ahead of print.

Authors

Bin Wu¹, Jinlong Liu², Lulu Jiang³, Jiakun Xu², Ruoheng Xuan², Yuting Ling⁴, Qianqian Guo⁴, Nan Jiang⁴, Ling Chen³, Changming Zhang⁵

Affiliations

¹ 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.
² Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
³ Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
⁴ Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
⁵ Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China. Electronic address: zhangchm8@mail.sysu.edu.cn.

PMID: 38669906
DOI: 10.1016/j.jocn.2024.04.023

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.

Keywords: Deep brain stimulation (DBS); Delay-onset seizures; Parkinson's disease (PD); Peri-electrode edema; Subthalamic nucleus (STN).