Erasmi, Richard and Granert, Oliver and Zorenkov, Dmitry and Falk, Daniela and Wodarg, Fritz and Deuschl, Günther and Witt, Karsten
(2018)
White matter changes along the electrode lead in patients treated with deep brain stimulation.
Frontiers in neurology, 9.
p. 983.
ISSN 1664-2295
Abstract
Introduction: Deep brain stimulation (DBS) is an established treatment for various
movement disorders. There is little data available about the potential damage to brain
parenchyma through DBS treatment. The objective of this study was to investigate the
occurrence of signal changes on magnetic resonance imaging (MRI) in patients treated
with DBS.
Methods: We retrospectively analyzed MRI scans of 30 DBS patients (21 patients
with Parkinson’s disease, 3 patients with dystonia and 6 patients with tremor) that had
undergone additional MRI scans after DBS surgery (ranging from 2 months to 8 years).
Axial T2 sequences were analyzed by two raters using a standardized lesion mapping
procedure.
Results: 26 out of 30 analyzed patients showed hyperintense white matter changes
surrounding the DBS lead (mean volume = 2.43ml). Lesions were prominent along the
upper half of the electrode lead within the subcortical white matter, with no abnormalities
along the lower lead. Their volume was significantly correlated to the time from surgery
to MRI and to the number of microelectrodes used in surgery, but was independent from
underlying disease (Parkinson’s disease, dystonia, tremor), target structure (STN, GPi,
VIM), demographical data, or cardiovascular risk factors.
Discussion: White matter changes along the electrode leads in DBS patients are
a frequent finding. These changes seem to evolve with certain latency after surgery
and might be radiologically classified as a gliosis. Our findings identify the number of
intraoperatively usedmicroelectrodes as a risk factor in the formation of gliosis. Therefore,
mechanical damage at the time of surgery and an individual tissue response might
contribute to their evolution. Further studies are needed to define the exact mechanisms
and their clinical impact.
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