Session Information
Date: Wednesday, September 25, 2019
Session Title: Surgical Therapy
Session Time: 1:15pm-2:45pm
Location: Les Muses Terrace, Level 3
Objective: To report on occurrence, symptoms, management and outcomes of SDE following DBS of either the subthalamic nucleus (STN) or Globus pallidum interna nucleus (GPi) DBS.
Background: Symptomatic delayed-onset edema (SDE) is an unexpected complication of deep brain stimulation (DBS) surgery in subjects with Parkinson’s disease (PD). The clinical presentation of SDE can be severe and no data are currently available on its clinical course and long term follow-up.
Method: We evaluated the patients with PD and STN- or GPi-DBS that developed SDE from June 2015 to 2017. The same neurosurgeon performed all surgeries utilizing single pass microelectrode recordings (MER). We implanted directional and conventional leads. Each patient underwent clinical evaluations, neuropsychological assessment and brain imaging follow-up until one year after SDE resolution.
Results: Out of the 55 implanted patients, seven developed SDE (12%). The patients who developed SDE did not differ to the others in terms of age, education, neuropsychological profile, disease duration, medication dosage and disease severity. Also of note, they didn’t show any particular cardiovascular risk factors. In all SDE cases, the brain MRI performed immediately after surgery were negative for hemorrhage or edema. Clinically, SDE onsets after an average of 5 days and confusional state, emotional lability and behaviour disorders were the most frequent symptoms. No motor deficit was reported. SDE was perielectrode (more 5 cm), bilateral, deep and extended to the frontal lobe. All seven patients were treated with dexamethasone and SDE improved over 4-6 weeks, till complete clinical remission. Still, the neuropsychological follow-up at one year showed a worsening in two patients (30%).
Conclusion: SDE can complicate DBS procedures and its etiology remains unclear, as no clear correlation with surgical aspects or patient-related factors was found. SDE transient nature suggests a conservative approach, but patients and caregivers must be alerted to this possible delay complication.
To cite this abstract in AMA style:
B. Minafra, NG. Pozzi, M. Picascia, R. Zangaglia, F. Bruschi, F. Avantaggiato, M. Todisco, D. Servello, C. Pacchetti. Symptomatic delayed-onset edema following deep brain stimulation for Parkinson’s disease: occurrence, symptoms, management and outcomes. Experience of a single center. [abstract]. Mov Disord. 2019; 34 (suppl 2). https://www.mdsabstracts.org/abstract/symptomatic-delayed-onset-edema-following-deep-brain-stimulation-for-parkinsons-disease-occurrence-symptoms-management-and-outcomes-experience-of-a-single-center/. Accessed June 14, 2025.« Back to 2019 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/symptomatic-delayed-onset-edema-following-deep-brain-stimulation-for-parkinsons-disease-occurrence-symptoms-management-and-outcomes-experience-of-a-single-center/