Article
Early and late histopathological changes following deep brain stimulation – Correlation with microlesional effect
Frühe und späte histopathologische Veränderungen nach chronischer Tiefenhirnstimulation: Korrelation mit dem Mikroläsionseffekt
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Published: | April 23, 2004 |
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Outline
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Objective
The clinical efficacy of deep brain stimulation (DBS) in treating tremor and other movement disorders is well established. Numerous patients develop a postoperative microlesional effect of variable degree and duration. Histological studies of this effect do not exist. Publications in the literature report autopsy findings obtained long after electrode placement.
Methods
The study presented here describes the autopsy findings in a patient, who died of pulmonary embolism eight weeks after electrode placement on the right side. Two years before this intervention, the patient had undergone electrode implantation into the ventrointermediate (VIM) nucleus on the contralateral side.
Results
The histopathological examination of the patient’s brain demonstrated the known long-term damage (mild gliosis) associated with chronic DBS, as well as early reactive changes consisting of pronounced microglial activation and perifocal edema. These early abnormalities are assumed to represent the histological correlate underlying the well-known microlesional effect produced by electrode implantation.
Conclusions
In conclusion, the case presented here suggests that the early changes associated with DBS are more pronounced than has hitherto been reported. While so far only marginal gliosis has been described, our findings demonstrate that tissue changes occur in an area of least 5-mm diameter around the electrode track.