Article
Leucencephalopathy in patients with Parkinson’s disease and deep brain stimulation – a higher risk profile?
Leukenzephalopathie bei Patienten mit Morbus Parkinson und Tiefenhirnstimulation – ein höheres Risikoprofil?
Search Medline for
Authors
-
Pawel Jarski
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
-
Turab Gasimov
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
-
Dorothee Mielke
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
-
Veit Rohde
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
-
Vesna Malinova
- Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
| Published: | June 26, 2020 |
|---|
Outline
Text
Objective: Leucencephalopathy (LE) is often detected on magnetic resonance imaging (MRI) in elderly patients. White matter lesions may interfere with the lead trajectories for deep brain stimulation (DBS) in patients with Parkinson’s Disease (PD) with the result of less possible trajectories for microelectrode recording (MER). Furthermore, LE is deemed to be possibly associated with higher complication rate after DBS-surgery. In this study we assessed the incidence of LE in PD-patients and evaluated a possible correlation with complications after DBS-surgery and with MER.
Methods: We performed a retrospective analysis of PD-patients, who underwent DBS-surgery. The presence of LE was evaluated on the pre-operative MRI and was quantified using the modified Fazekas scale. Postoperative complications such as bleeding and infections were documented from the medical records. The number of used trajectories and the length of subthalamic nucleus (STN) signal were documented. DBS-efficacy was calculated using the side specific motor symptom ratio (UPDRS-3, Unified Parkinson Disease Rating Scale, recorded for motor symptoms only on each side separately; stimulation ON medication OFF postoperative divided by medication OFF preoperatively) at one-year follow-up.
Results: A total of 141 patients were included. The mean age was 61.0 years (range 42-81). The incidence of LE was 37.59% (Fazekas 1 in 69.8%, 2 in 22.6%, and 3 in 7.5%). Periventricular lesions (PVL) were found in 51.78% (73/141) and deep lesions (DL) in 59.6% (84/141). Postoperative complications occurred in 12% (17/141), one patient had superficial peri-lead hemorrhage and the rest 16 patients had an infection. We found a statistically significant correlation of complications with PVL (r=0.17, p=0.03), but not with DL. There was a significant correlation of the LE with the length of STN-signal (r=0.18, p=0.02). We found no correlation of LE with the number of trajectories or with the side specific motor symptom ratio.
Conclusion: We confirmed a high incidence of LE in PD-patients, which correlated with the length of STN-signal, but did not result in less DBS-efficacy. PVL correlated significantly with the complication rate. Considering the low incidence of postoperative bleeding and the high incidence of PVL and DL, white matter lesions seem not to be a risk factor for postoperative bleeding after DBS-surgery.
