Suicidal behavior observed after deep brain stimulation for Parkinson’s disease

According to a study published in Neurology.

Patients with PD who underwent bilateral STN-DBS in a single center in France between 1993 and 2016 were included in the retrospective study (n = 534). Medical records were used to collect the data. Researchers matched each patient who successfully (0.75%) or attempted (4.11%) suicide to 2 patients with PD who underwent STN-DBS and did not engage in suicidal behaviors d accompaniment according to age, sex and year of intervention. Neuropsychological assessment data, including that obtained from frontal and Beck Depression Inventory scores, were collected and compared from the pre- and postoperative periods.

In an analysis adjusted for age and sex, the suicide rate observed in the cohort (187.20 per 100,000 per year) during the first year after STN-DBS was higher than the rate expected from the National Observatory. suicide risk (23.10 out of 100,000 per year). The postoperative suicide rate remained stable during the second and third years after the intervention. Compared to the 52 control patients, the 26 patients who completed or attempted suicide had a more frequent history of suicidal thoughts/attempts (5.76% vs. 42.31%, respectively; P =.00018) and psychotic symptoms (11.53% versus 38.46%, respectively; P = 0.013) and a higher percentage of family psychiatric history (0.0% versus 15.4%, respectively; P = 0.01) and the use of psychotropic medications (40.4% versus 73.1%, respectively; P =.013). Those who attempted/succeeded in suicide also had higher preoperative frontal scores (41.87 vs 37.41; P = 0.011) and Beck Depression Inventory scores (15.90 vs. 10.44; P =.012).


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Limitations of the study include the retrospective design, the lack of a nonsurgical control group, and the small number of participants in each group.

Based on their findings, the researchers suggest that “clinicians should actively investigate suicidal ideation and pay more attention to history of psychiatric problems and, in particular, suicidal ideation/suicide attempt, verbalized suicidal ideation, to preoperative depression and the use of psychotropic medications.” in patients with PD who are to undergo STN-DBS.

Reference

Giannini G, François M, Lhommée E, et al. Suicide and suicide attempts after stimulation of the subthalamic nucleus in Parkinson’s disease [published online May 17, 2019]. Neurology. doi:10.1212/WNL.0000000000007665