de Cuba Catherine M K E, Albanese Alberto, Antonini Angelo, Cossu Giovanni, Deuschl Günther, Eleopra Roberto, Galati Alejandro, Hoffmann Carel F E, Knudsen Karina, Landi Andrea, Lanotte Michele Maria R, Marcante Andrea, Mosch Arne, Pilleri Manuela, Reich Martin M, Ricchi Valeria, Rinaldo Sara, Romito Luigi M, Saba Felipe S, Sacristan Horacio E, Schuurman P Richard, Trezza Andrea, van den Munckhof Pepijn, Volkmann Jens, Zibetti Maurizio, Contarino Maria Fiorella
Department of Neurosurgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Neurology, Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy; Department of Neurology, Istituto Clinico Humanitas, Via Alessandro Manzoni 113, Rozzano, Milano, Italy.
Parkinsonism Relat Disord. 2016 Nov;32:108-115. doi: 10.1016/j.parkreldis.2016.09.007. Epub 2016 Sep 6.
Deep brain stimulation (DBS) is effective for some neurological and psychiatric conditions. Idiopathic delayed-onset edema (IDE) surrounding the leads has been anecdotally reported. The etiology, predisposing factors and prognosis of this complication are unknown. We present a multicenter case series of patients with IDE, and a systematic literature review, aimed at defining the pathophysiology and identifying appropriate treatment strategies.
IDE was defined as edema along the DBS lead, occurring ≥72 h 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.
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.
IDE is a rare complication of DBS procedures, presenting from few days to months after surgery. Symptoms can be mild and not-specific, and the condition is self-limiting. The diagnosis of IDE is made after exclusion of vascular events or infections. The pathophysiology is still unexplained. The recognition of this complication can help avoiding unnecessary surgical procedures (system explantation) and antibiotic treatment.
深部脑刺激（DBS）对某些神经和精神疾病有效。有零星报道称，电极周围会出现特发性迟发性水肿（IDE）。这种并发症的病因、诱发因素和预后尚不清楚。我们呈现了一组IDE患者的多中心病例系列，并进行了系统的文献综述，旨在明确其病理生理学并确定合适的治疗策略。
IDE被定义为DBS电极周围的水肿，在术后≥72小时出现，且不存在创伤、血管事件或感染。以标准化方式收集IDE患者的信息。在PubMed上进行了系统检索。
描述了12例新出现14次IDE发作的患者。从文献中识别出38例患者。未发现常见的手术方面或患者相关因素可作为IDE发作的风险预测因素。症状包括刺激效果恶化、癫痫发作和局灶性神经体征。尽管该病症具有自限性，平均28.5天症状缓解，但有3例患者接受了手术翻修，7例接受了抗生素治疗。
IDE是DBS手术的一种罕见并发症，在术后数天至数月出现。症状可能轻微且不具特异性，该病症具有自限性。IDE的诊断是在排除血管事件或感染后做出的。其病理生理学仍未得到解释。认识到这种并发症有助于避免不必要的手术操作（系统取出）和抗生素治疗。
