Peri-Lead Edema After Deep Brain Stimulation Surgery for Parkinson Disease: A Management Challenge

Abstract

Deep brain stimulation (DBS) is a well-established surgical treatment for Parkinson’s disease. Peri-lead edema (PLE) is a poorly understood complication of DBS. We hereby report three cases of unilateral PLE after bilateral subthalamic nucleus (STN)-DBS and discuss its diagnosis and management. Patient 1 reported a new-onset headache one month after his surgical procedure. Antibiotic treatment was administered. His complaint resolved two days later. Patient 2 presented in an acute confusional state on the seventh post-operative day. He was treated with corticosteroid. Within a few days clear clinical improvement was seen. Patient 3 developed PLE 56 hours postoperatively. He remained asymptomatic and the edema improved completely without any treatment. Two patients showed an abrupt change in impedance evaluation. PLE is an underestimated complication of DBS. It is clinically heterogeneous and its management is still lacking. Impedance evaluation can help in its early recognition, avoiding unnecessary medical or surgical procedures.