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Neurohistopathological Findings of the Brain Parenchyma After Long-Term Deep Brain Stimulation: Case Series and Systematic Literature Review
Journal article   Open access   Peer reviewed

Neurohistopathological Findings of the Brain Parenchyma After Long-Term Deep Brain Stimulation: Case Series and Systematic Literature Review

Juan Vivanco-Suarez, Timothy Woodiwiss, Kimberly L. Fiock, Marco M. Hefti, Ergun Y. Uc, Nandakumar S. Narayanan and Jeremy D.W. Greenlee
Parkinsonism & related disorders, Vol.133, 107243
04/2025
DOI: 10.1016/j.parkreldis.2024.107243
PMCID: PMC12981316
PMID: 39721929
url
https://pubmed.ncbi.nlm.nih.gov/39721929/View
Open Access

Abstract

Efficacy of deep brain stimulation (DBS) is established for several movement and psychiatric disorders. However, the mechanism of action and local tissue changes are incompletely described. We describe neurohistopathological findings of 9 patients who underwent DBS for parkinsonism and performed a systematic literature review on postmortem pathologic reports post-DBS. We performed a retrospective study of patients who underwent DBS for Parkinsonism between 2000-2023 and had postmortem neurohistopathological assessments. Demographics and clinical features were collected. Levodopa equivalent daily dose (LEDD) and total electrical energy delivered (TEED) were calculated. A systematic literature review was conducted. Postmortem assessment of 9 DBS patients was performed (7 Parkinson’s disease [PD], 1 Parkinsonism, 1 Multiple System Atrophy with pre-DBS clinical diagnosis of PD). Median age at DBS was 65 years (range, 54-69), 8 were male. Subthalamic nucleus was targeted in 8 patients, globus pallidus in 1. Median DBS duration was 65 months (range, 7-264). Post-DBS LEDD reduction was found in 7/9 patients and TEED increased over time in all cases. There were no DBS-related deaths. Neurohistopathological assessment showed gliosis in 7 patients and activated microglial infiltration in 1. In the literature (between 1977-2021), 59 patients with postmortem post-DBS findings were identified: 26 (44%) PD, 20 (34%) pain, and 13 (22%) other conditions. Findings confirm presence of a local tissue reaction (gliosis and activated microglial) around the implanted leads. The effect of local changes on the clinical efficacy of DBS is not established. Further DBS postmortem studies and standardization of tissue processing are needed. •A retrospective study of patients who underwent DBS for movement disorders between 2000-2023 and had postmortem neurohistopathological assessments was performed. Additionally, a systematic literature review on postmortem studies was performed.•Postmortem neurohistopathologic assessment of 9 patients who underwent DBS for Parkinson’s (7 Parkinson’s disease, 1 Parkinsonism, 1 Multiple System Atrophy) was performed, and the neurohistopathological post-DBS findings of 59 patients from the literature were reported.•Of the 9 patients, the median age at DBS was 65 years, the subthalamic nucleus was targeted in 8 patients, and the median DBS duration was 65 months. On neurohistopathological assessment, gliosis was found in 7 and activated microglial infiltration in 1. DBS remained effective over time as evident by the reduced Levodopa equivalent daily dose (in 5/7 gliosis patients). Total electrical energy delivered increased over time in all patients.•The presence of local tissue reaction around the DBS lead was confirmed. However, the clinical effect of these local changes was not established. Future postmortem studies and standardization of tissue processing are needed.
 Neuropathology Gliosis Parkinson’s disease Postmortem

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