Vilela-Filho Osvaldo, Oliveira-Alves Déborah, Alvim-Alves Déborah, Silva Délson J
Division of Neurosurgery, Department of Surgery, Medical School, Federal University of Goiás, Goiânia, Goiás, Brazil.
Nucleus of Neurosciences, Clinics Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil.
J Neurosurg Case Lessons. 2024 Oct 28;8(18). doi: 10.3171/CASE24502.
Deep brain stimulation (DBS) is commonly used to treat Parkinson's disease (PD) and other movement disorders when other treatments fail. Although DBS can significantly improve motor symptoms, it carries risks such as infections, which can require multiple surgeries and prolonged antibiotic therapy. Research on the long-term neurological effects of DBS-related infections is limited.
A 58-year-old man with a 13-year history of PD, refractory to optimized clinical management, underwent subthalamic nucleus (STN) DBS after previous contralateral lesioning of the posterior subthalamic area. Postoperatively, the DBS lead migrated upward and was repositioned, but he developed perielectrode cerebritis 5 days later. The DBS system was completely removed, and he underwent a 28-day course of intravenous antibiotics. Initially, his motor symptoms remained unchanged, but 4 months later, he experienced a significant and sustained motor symptom improvement that continued until the last follow-up assessment (40 months). Magnetic resonance imaging performed 2 years after the explantation showed gliosis and hemosiderin deposition in the STN, suggesting that the infection-induced gliosis had a lesion-like effect, leading to the observed clinical improvement.
This case suggests that infection-induced gliosis from DBS complications can unexpectedly result in long-term motor symptom improvements, potentially influencing future management strategies for similar cases. https://thejns.org/doi/10.3171/CASE24502.
当其他治疗方法无效时，脑深部电刺激（DBS）常用于治疗帕金森病（PD）和其他运动障碍。尽管DBS能显著改善运动症状，但它存在感染等风险，这可能需要多次手术和长期抗生素治疗。关于DBS相关感染的长期神经学影响的研究有限。
一名有13年帕金森病病史的58岁男性，对优化的临床管理无效，在先前对侧丘脑底后区损伤后接受了丘脑底核（STN）DBS治疗。术后，DBS电极向上迁移并重新定位，但5天后他发生了电极周围脑炎。DBS系统被完全移除，他接受了为期28天的静脉抗生素治疗。最初，他的运动症状保持不变，但4个月后，他经历了显著且持续的运动症状改善，这种改善一直持续到最后一次随访评估（40个月）。植入物取出2年后进行的磁共振成像显示，STN有胶质增生和含铁血黄素沉积，提示感染诱导的胶质增生具有类似病变的作用，导致了观察到的临床改善。
该病例表明，DBS并发症引起的感染诱导性胶质增生可能意外导致长期运动症状改善，这可能会影响未来类似病例的管理策略。https://thejns.org/doi/10.3171/CASE24502。
