Objective: To assess whether development of post-operative symptomatic edema around deep brain stimulation (DBS) leads impacts clinical outcomes.

Background: Post-operative symptomatic delayed edema around the lead is a reported complication of DBS surgery. Patients typically present a few days after lead implantation with varied neurological symptoms including confusion, diplopia, headaches, speech and gait difficulty. The phenomenon underlying development of edema is not well understood. Resolution of edema may take several weeks and treatment with steroids has been suggested. Although, complete resolution of edema occurs within several weeks, it is unclear whether this complication impacts clinical outcomes.

Methods: All Parkinson’s disease (PD) patients who underwent subthalamic nucleus (STN) DBS implantation from January 2007 to 2015 were reviewed. Patients who developed delayed symptomatic lead edema were identified, and UPDRS part III, Parkinson Disease Questionnaire (PDQ-39) total and Montreal Cognitive Assessment (MoCA) scores were analyzed 1-year post-surgery to assess motor outcome, quality of life and cognitive status.

Results: A total of 189 patients underwent 363 STN lead placements. Of these, 12 cases (3.3% per lead) of delayed symptomatic non-hemorrhagic edema were identified on CT head in 10 patients (5.3%) who reported new neurological symptoms. The average age at the time of surgery in these patients was 63.5 years (range 56-70 years) and mean disease duration was 7.8 years (range 1.9-18.9 years). The mean duration for the diagnosis of edema was 6.4 days after lead implantation. None of the patients had edema on immediate post-operative scan. The symptoms prompting evaluation for edema included headaches (n=2), seizures (n=3), mild confusion (n=3) and gait difficulty (n=5). Patients were treated with a short course of steroids and seizure prophylaxis with resolution of edema within 6 weeks. At 1-year post-DBS, there was significant improvement in motor scores (43.9%, p=0.008) and quality of life (35.3%, p=0.03), without decline in cognitive function (26.7 vs 26.6, p > 0.80).

Conclusions: Symptomatic lead edema after DBS surgery is a rare complication which typically resolves over time. In our series, there were no long-term sequelae of this complication and clinical outcomes were comparable to that reported in the literature.

References: Nazzaro JM, Pahwa R, Lyons KE. Symptomatic, non-infectious, non-hemorrhagic edema after subthalamic nucleus deep brain stimulation surgery for Parkinson’s disease. Journal of the neurological sciences. 2017;383:42-46.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-post-operative-symptomatic-lead-edema-associated-with-subthalamic-deep-brain-stimulation-on-clinical-outcomes/