Objective: To characterize perioperative seizures in movement disorder patients undergoing deep brain stimulation (DBS) and their outcome.

Background: Although seizure is a rare complication of DBS, knowing the occurrence and prognosis of seizures could guide clinical care. Furthermore, knowledge regarding anti-epileptic drugs (AED) and duration of treatment could benefit treating neurologists.

Method: We carried out a retrospective chart review at our center and analyzed patients who underwent DBS for movement disorders from May 2013 to June 2021. Seizure occurrence, treatment, and outcome were determined with at least 6 month follow up after surgery.

Results: Of the 204 patients analyzed, 24 had new-onset clinically definite seizures with an incidence of 11.8%. The median frequency of clinical seizures was 1 (IQR 1-2 seizures). The median length of stay (LOS) for these patients was 2 days (IQR 1-4 days), which was 1 day more than the LOS for patients without seizures. The seizure types were focal motor (N=4; 16.7%), focal non-motor (N=1, 4.17%), focal motor to bilateral tonic-clonic (N=5, 20.8%), and generalized (N=14; 58.3%) seizures. 1 patient had clinical status epilepticus. The median duration of AED-use was 2.5 months (IQR 1-6 months). AEDs were continued in 5 (20.8%) patients for more than 6 months. Long term monitoring electroencephalography (LTM) was utilized in 8 patients with only 1 patient demonstrating electrographic seizures. 3 patients (12.5%) had recurrent seizures within the 6-month postoperative period – 2 patients who had an associated postoperative complication (intracranial hemorrhage, systemic infection, stroke, or subdural empyema) and only 1 patient who had no postoperative complications.

Conclusion: In this single center study, the incidence of new-onset seizures was 11.8%. 75% had only 1 perioperative seizure related to electrode placement. Seizure recurrence was seen mostly in patients who had postoperative complications. 1 patient developed epilepsy at 6 months, postoperatively. Median duration for AED use was 2.5 months in this study. Future studies should aim to investigate the duration for AEDs for these patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/characterization-of-perioperative-seizures-in-patients-undergoing-deep-brain-stimulation-for-movement-disorders-a-single-center-study/