Abstract

• Delayed-onset seizures after deep brain stimulation (DBS) surgery were seldom reported in previous studies. We studied 341 PD patients who underwent STN-DBS surgery from 2006 to 2021 in our department retrospectively.

• Five patients experienced seizures after DBS surgery with an incidence of 1.47 %. All 5 seizures cases were characterized as delayed-onset with an average time of 12 days postoperatively, which was different from the previous studies. In the further risk factors analysis of seizures, we found that the average diameter of peri-electrode edema of patients with seizures was larger than the average diameter of patients without seizures, which indicated that peri-electrode edema was risk factor for delayed-onset seizures after DBS surgery.

• Further multivariate analysis confirmed the result. Our study is the first report focusing on clinical characteristics and risk factors of delayed-onset seizures after DBS surgery based on a case series.

• Although DBS related seizure is uncommon complication, patients who experienced seizures are still exposed in risks of trauma and damage to the implanted simulator. We believe that these findings were useful for prevention and management of seizures associated with DBS surgery.

Introduction

Deep brain stimulation (DBS) is a well-established surgical therapy for some movement and psychiatric disorders. Patients are exposed in risks of trauma and implanted simulator damage when seizures occur, though seizures are not common postoperative adverse event of deep brain stimulation surgery. Previous studies indicated that the risk factors for seizures related to DBS included hemorrhage, peri-electrode edema, and increased age [1, 2, 3]. Most of the seizures occurred during electrode implantation procedures or within 48 h after DBS surgery [1, 2, 3], and delayed-onset seizures were seldom reported. However, this seizures incidence time-point presents quite different from those reports when retrospectively screening those PD patients who underwent subthalamic nucleus (STN) DBS in our center. We found that the seizures after DBS surgery were mainly delayed-onset (1–۲ weeks after surgery). Therefore, this study summarized the clinical characteristics of delayed-onset seizures after DBS surgery and analyzed related risk factors.

Conclusions

Delayed-onset seizure after STN-DBS treating PD patients was uncommon with an incidence of 1.47 %. The seizures were transient and self-limiting, not easily developing into chronic epilepsy. Peri-electrode edema was a risk factor for delayed-onset seizures after DBS surgery. Patients with an average peri-electrode edema diameter > 2.70 cm had a higher risk to develop seizures.