Case Report Of Peri-Lead Edema Leading To Seizure After Deep Brain Stimulation Surgery And Literature Review

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Background: Deep brain stimulation (DBS) has become a frequently performed surgery in patients with Parkinson’s disease (PD). It is not free of surgical complications and a mysterious one is cerebral sterile peri-lead edema. Herein, we report on a case of a PD patient with symptomatic peri-lead edema presenting with seizures after surgery and recovered completely after conservative therapy. Case presentation: A 68-year-old female, with an 8-year history of rigidity-dominant Parkinson’s disease. After an all-around previous evaluation by neurologists, she was referred for bilateral subthalamic nucleus (STN) DBS surgery. There were no intraoperative complications. Two days after discharge (postoperative day six) she presented to the emergency department with a new onset of seizures. A subsequent 1.5 T MRI of the brain under stimulation off state showed obvious bilateral vasogenic edema extending from STN targets to cortex. Initiated corticosteroids (intravenous dexamethasone 10 mg per day) with a remarkable completely infectious workup. Levetiracetam (500 mg p.o. bid) was given for seizure prophylaxis. The follow-up brain 1.5T MRI imaging (postoperative day thirty-six) revealed that the edema has improved. At the patient’s latest follow-up visit, 12 months after initial lead placement, she demonstrated expected improvement in bradykinesia, gait, and rigidity with a significant reduction in dyskinesia and medication requirement and no evidence of cognitive or memory impairment. Conclusions: : Symptomatic peri-lead edema is no more a relatively rare side effect of DBS surgery. A correct diagnosis can avoid futile and costly procedures such as system removal and antibiotic prescriptions. Eventually the outcome was good in most cases.

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