Comprehensive analysis of risk factors for seizures after deep brain stimulation surgery

Clinical article

Restricted access

Object

The aim of this study was to assess risk factors for postoperative seizures after deep brain stimulation (DBS) lead implantation surgery and the impact of such seizures on length of stay and discharge disposition.

Methods

The authors reviewed a consecutive series of 161 cases involving patients who underwent implantation of 288 electrodes for treatment of movement disorders at a single institution to determine the absolute risk of postoperative seizures, to describe the timing and type of seizures, to identify statistically significant risk factors for seizures, and to determine whether there are possible indications for seizure prophylaxis after DBS lead implantation. The electronic medical records were reviewed to identify demographic details, medical history, operative course, and postoperative outcomes and complications. To evaluate significant associations between potential risk factors and postoperative seizures, both univariate and multivariate analyses were performed.

Results

Seven (4.3%) of 161 patients experienced postoperative seizures, all of which were documented to have been generalized tonic-clonic seizures. In 5 (71%) of 7 cases, patients only experienced a single seizure. Similarly, in 5 of 7 cases, patients experienced seizures within 24 hours of surgery. In 6 (86%) of the 7 cases, seizures occurred within 48 hours of surgery. Univariate analysis identified 3 significant associations (or risk factors) for postoperative seizures: abnormal findings on postoperative imaging (hemorrhage, edema, and or ischemia; p < 0.001), age greater than 60 years (p = 0.021), and transventricular electrode trajectories (p = 0.023). The only significant factor identified on multivariate analysis was abnormal findings on postoperative imaging (p < 0.0001, OR 50.4, 95% CI 5.7–444.3). Patients who experienced postoperative seizures had a significantly longer length of stay than those who were seizure free (mean ± SD 5.29 ± 3.77 days vs 2.38 ± 2.38 days; p = 0.002, Student 2-tailed t-test). Likewise, final discharge to home was significantly less likely in patients who experienced seizures after implantation (43%) compared with those patients who did not (92%; p = 0.00194, Fisher exact test).

Conclusions

These results affirm that seizures are an uncommon complication of DBS surgery and generally occur within 48 hours of surgery. The results also indicate that hemorrhage, edema, or ischemia on postoperative images (“abnormal” imaging findings) increases the relative risk of postoperative seizures by 30- to 50-fold, providing statistical credence to the long-held assumption that seizures are associated with intracranial vascular events. Even in the setting of a postimplantation imaging abnormality, long-term anticonvulsant therapy will not likely be required because none of our patients developed chronic epilepsy.

Abbreviations used in this paper: DBS = deep brain stimulation; GPi = globus pallidus internus; PD = Parkinson disease; STN = subthalamic nucleus; VIM = ventral intermediate nucleus of the thalamus.

Article Information

Address correspondence to: Nader Pouratian, M.D., Ph.D., Department of Neurosurgery, David Geffen School of Medicine at UCLA, 10945 Le Conte Avenue, Suite 2120, Los Angeles, California 90095. email: npouratian@mednet.ucla.edu.

Please include this information when citing this paper: published online May 6, 2011; DOI: 10.3171/2011.4.JNS102075.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Postoperative images obtained in the 6 patients with postoperative radiographic abnormalities out of the 7 patients with postimplantation seizures. These images demonstrate evidence of a remote right frontal hemorrhage and edema surrounding the right electrode (A), right frontal and parietal subarachnoid hemorrhage (B), right frontal hyperintensity on T2-weighted MR imaging suggestive of edema or ischemia (C), a small amount of left intraventricular hemorrhage (D), left frontal hemorrhage (E), and a small amount of left intraventricular hemorrhage (F).

References

  • 1

    Bao YHBramlett HMAtkins CMTruettner JSLotocki GAlonso OF: Post-traumatic seizures exacerbate histopathological damage after fluid-percussion brain injury. J Neurotrauma 28:35422011

    • Search Google Scholar
    • Export Citation
  • 2

    Beghi E: Overview of studies to prevent posttraumatic epilepsy. Epilepsia 44:Suppl 1021262003

  • 3

    Ben-Haim SAsaad WFGale JTEskandar EN: Risk factors for hemorrhage during microelectrode-guided deep brain stimulation and the introduction of an improved microelectrode design. Neurosurgery 64:7547632009

    • Search Google Scholar
    • Export Citation
  • 4

    Burneo JGFang JSaposnik G: Impact of seizures on morbidity and mortality after stroke: a Canadian multi-centre cohort study. Eur J Neurol 17:52582010

    • Search Google Scholar
    • Export Citation
  • 5

    Coley EFarhadi RLewis SWhittle IR: The incidence of seizures following Deep Brain Stimulating electrode implantation for movement disorders, pain and psychiatric conditions. Br J Neurosurg 23:1791832009

    • Search Google Scholar
    • Export Citation
  • 6

    Elias WJFu KMFrysinger RC: Cortical and subcortical brain shift during stereotactic procedures. J Neurosurg 107:9839882007

  • 7

    Follett KAWeaver FMStern MHur KHarris CLLuo P: Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease. N Engl J Med 362:207720912010

    • Search Google Scholar
    • Export Citation
  • 8

    Hooper JTaylor RPentland BWhittle IR: A prospective study of thalamic deep brain stimulation for the treatment of movement disorders in multiple sclerosis. Br J Neurosurg 16:1021092002

    • Search Google Scholar
    • Export Citation
  • 9

    Johnson RDQadri SRJoint CMoir LGreen ALAziz TZ: Perioperative seizures following deep brain stimulation in patients with multiple sclerosis. Br J Neurosurg 24:2892902010

    • Search Google Scholar
    • Export Citation
  • 10

    Khan AABanerjee A: The role of prophylactic anticonvulsants in moderate to severe head injury. Int J Emerg Med 3:1871912010

  • 11

    Seijo FJAlvarez-Vega MAGutierrez JCFdez-Glez FLozano B: Complications in subthalamic nucleus stimulation surgery for treatment of Parkinson's disease. Review of 272 procedures. Acta Neurochir (Wien) 149:8678762007

    • Search Google Scholar
    • Export Citation
  • 12

    Temkin NR: Preventing and treating posttraumatic seizures: the human experience. Epilepsia 50:Suppl 210132009

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 244 244 11
Full Text Views 169 128 3
PDF Downloads 160 133 3
EPUB Downloads 0 0 0

PubMed

Google Scholar