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

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 ($0.12{\pm}0.17mg/dL$, n=46), mean CRP levels were significantly elevated after lead insertion day 2 and 4 ($1.68{\pm}1.83mg/dL$, n=46 and $0.76{\pm}0.38mg/dL$, 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 ($3.41{\pm}2.56mg/dL$, n=46, respectively, p<0.01). This elevation in post-IPG day 2 rapidly declined in day 4 ($1.24{\pm}1.29mg/dL$, n=46, p<0.05) and normalized to preoperative value at day 6 ($0.42{\pm}0.33mg/dL$, 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 ($3.99{\pm}2.80mg/dL$, n=30, and $2.31{\pm}1.56mg/dL$, 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.