Objective: We present a multicenter case series of patients with idiopathic delayed-onset edema (IDE) surrounding the deep brain stimulation (DBS) leads, and a systematic literature review, aimed at defining the pathophysiology and identifying appropriate treatment strategies.

Background: DBS is effective for some neurological and psychiatric conditions. IDE has been anectodally reported. The etiology, predisposing factors and prognosis of this complication are unknown.

Methods: IDE was defined as edema along the DBS lead, occurring ≥ 72 hours 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 a few days to months after surgery. Symptoms can be mild and not-specific. The diagnosis of IDE is made after exclusion of vascular events or infections. The pathophysiology is still unexplained. IDE is self-limiting; steroidal treatment might shorten recovery time. It may be safer to switch off stimulation or apply constant-current stimulation. The recognition of this complication can help avoiding unnecessary surgical procedures (system explantation) and antibiotic treatment.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/idiopathic-delayed-onset-edema-surrounding-deep-brain-stimulation-leads-insights-from-a-case-series-and-systematic-literature-review/