J Korean Neurosurg Soc.  2015 Oct;58(4):368-372. 10.3340/jkns.2015.58.4.368.

Chronological Changes of C-Reactive Protein Levels Following Uncomplicated, Two-Staged, Bilateral Deep Brain Stimulation

• Kim JH
• Ha SW
• Choi JG
• Son BC

• KMID: 2114375
• DOI: http://doi.org/10.3340/jkns.2015.58.4.368

Abstract

OBJECTIVE
The occurrence of acute cerebral infection following deep brain stimulation (DBS) is currently being reported with elevation of C-reactive protein (CRP) level. The aim of the present study was to establish normal range of the magnitude and time-course of CRP increases following routine DBS procedures in the absence of clinical and laboratory signs of infection.
METHODS
A retrospective evaluation of serial changes of plasma CRP levels in 46 patients undergoing bilateral, two-staged DBS was performed. Because DBS was performed as a two-staged procedure involving; implantation of lead and internal pulse generator (IPG), CRP was measured preoperatively and postoperatively every 2 days until normalization of CRP (post-lead implantation day 2 and 4, post-IPG implantation day 2, 4, and 6).
RESULTS
Compared with preoperative CRP levels (0.12+/-0.17 mg/dL, n=46), mean CRP levels were significantly elevated after lead insertion day 2 and 4 (1.68+/-1.83 mg/dL, n=46 and 0.76+/-0.38 mg/dL, n=16, respectively, p<0.001). The mean CRP levels at post-lead implantation day 2 were further elevated at post-IPG implantation day 2 (3.41+/-2.56 mg/dL, n=46, respectively, p<0.01). This elevation in post-IPG day 2 rapidly declined in day 4 (1.24+/-1.29 mg/dL, n=46, p<0.05) and normalized to preoperative value at day 6 (0.42+/-0.33 mg/dL, n=46, p>0.05). Mean CRP levels after IPG implantation were significantly higher in patients whose IPGs were implanted at post-lead day 3 than those at post-lead day 5-6 (3.99+/-2.80 mg/dL, n=30, and 2.31+/-1.56 mg/dL, n=16, respectively, p<0.05). However, there was no difference in post-IPG day 2 and 4 between them (p>0.05).
CONCLUSION
The mean postoperative CRP levels were highest on post-IPG insertion day 2 and decreased rapidly, returning to the normal range on post-IPG implantation day 6. The duration of post-lead implantation period influenced the magnitude of CRP elevation at post-IPG insertion day 2. Information about the normal response of CRP following DBS could help to avoid unnecessary diagnostic and therapeutic efforts.

Keyword

C-reactive protein; Deep brain stimulation; Inflammation; Intracerebral infection

MeSH Terms

C-Reactive Protein*
Deep Brain Stimulation*
Humans
Inflammation
Plasma
Reference Values
Retrospective Studies
C-Reactive Protein

Figure

• 

  Fig. 1 An error-box chart showing the mean CRP course of the 46 patients with a rapid increase in the mean CRP value reaching the peak on the second post-IPG implantation day and declining by the 6th postoperative day. *Statistical significance between groups (p<0.05, paired t-test) and the dotted line indicates the upper limit of normal range of CRP (0.01-0.47 mg/dL). CRP : C-reactive protein, PG : implantable pulse generator.

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