Incidence and risk factors for seizures associated with deep brain stimulation surgery

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  • 1 Departments of Neurosurgery and
  • 3 Neurology, University of Alabama at Birmingham;
  • 2 University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; and
  • 4 Department of Neurological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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OBJECTIVE

The objective of this study was to determine the incidence of seizures following deep brain stimulation (DBS) electrode implantation and to evaluate factors associated with postoperative seizures.

METHODS

The authors performed a single-center retrospective case-control study. The outcome of interest was seizure associated with DBS implantation. Univariate analyses were performed using the Student t-test for parametric continuous outcomes. The authors used the Kruskal-Wallis test or Wilcoxon rank-sum test for nonparametric continuous outcomes, chi-square statistics for categorical outcomes, and multivariate logistic regression for binomial variables.

RESULTS

A total of 814 DBS electrode implantations were performed in 645 patients (478 [58.7%] in men and 520 [63.9%] in patients with Parkinson’s disease). In total, 22 (3.4%) patients who had undergone 23 (2.8%) placements experienced seizure. Of the 23 DBS implantation–related seizures, 21 were new-onset seizures (3.3% of 645 patients) and 2 were recurrence or worsening of a prior seizure disorder. Among the 23 cases with postimplantation-related seizure, epilepsy developed in 4 (17.4%) postoperatively; the risk of DBS-associated epilepsy was 0.50% per DBS electrode placement and 0.63% per patient. Nine (39.1%) implantation-related seizures had associated postoperative radiographic abnormalities. Multivariate analyses suggested that age at surgery conferred a modest increased risk for postoperative seizures (OR 1.06, 95% CI 1.02–1.10). Sex, primary diagnosis, electrode location and sidedness, and the number of trajectories were not significantly associated with seizures after DBS surgery.

CONCLUSIONS

Seizures associated with DBS electrode placement are uncommon, typically occur early within the postoperative period, and seldom lead to epilepsy. This study suggests that patient characteristics, such as age, may play a greater role than perioperative variables in determining seizure risk. Multiinstitutional studies may help better define and mitigate the risk of seizures after DBS surgery.

ABBREVIATIONS DBS = deep brain stimulation.

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Contributor Notes

Correspondence Barton L. Guthrie: University of Alabama at Birmingham, AL. bguthrie@uabmc.edu.

INCLUDE WHEN CITING Published online August 7, 2020; DOI: 10.3171/2020.5.JNS20125.

Disclosures Dr. Walker: consultant for Medtronic and Boston Scientific and research funding from the National Institutes of Health (UH3 NS100553) and the Michael J. Fox Foundation (MJFF 15098). Dr. Bernstock: positions/equity in CITC Ltd. and Avidea Technologies and member of the board of scientific advisors for POCKiT Diagnostics.

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