A multicentre study on suicide outcomes following subthalamic stimulation for Parkinson's disease

Abstract

Subthalamic nucleus deep brain stimulation improves motor symptoms and quality of life in advanced Parkinson's disease. As after other life-altering surgeries, suicides have been reported following deep brain stimulation for movement disorders. We sought to determine the suicide rate following subthalamic nucleus deep brain stimulation for Parkinson's disease by conducting an international multicentre retrospective survey of movement disorder and surgical centres. We further sought to determine factors associated with suicide attempts through a nested case-control study. In the survey of suicide rate, 55/75 centres participated. The completed suicide percentage was 0.45% (24/5311) and attempted suicide percentage was 0.90% (48/5311). Observed suicide rates in the first postoperative year (263/100,000/year) (0.26%) were higher than the lowest and the highest expected age-, gender- and country-adjusted World Health Organization suicide rates (Standardized Mortality Ratio for suicide: SMR 12.63-15.64; P < 0.001) and remained elevated at the fourth postoperative year (38/100,000/year) (0.04%) (SMR 1.81-2.31; P < 0.05). The excess number of deaths was 13 for the first postoperative year and one for the fourth postoperative year. In the case-control study of associated factors, 10 centres participated. Twenty-seven attempted suicides and nine completed suicides were compared with 70 controls. Postoperative depression (P < 0.001), being single (P = 0.007) and a previous history of impulse control disorders or compulsive medication use (P = 0.005) were independent associated factors accounting for 51% of the variance for attempted suicide risk. Attempted suicides were also associated (P < 0.05) with being younger, younger Parkinson's disease onset and a previous suicide attempt. Completed suicides were associated with postoperative depression (P < 0.001). Postoperative depression remained a significant factor associated with attempted and completed suicides after correction for multiple comparisons using the stringent Bonferroni correction. Mortality in the first year following subthalamic nucleus deep brain stimulation has been reported at 0.4%. Suicide is thus one of the most important potentially preventable risks for mortality following subthalamic nucleus deep brain stimulation for Parkinson's disease. Postoperative depression should be carefully assessed and treated. A multidisciplinary assessment and follow-up is recommended.

Complications of Subthalamic Nucleus Stimulation in Parkinson's Disease

“…Suicide is the most important factor of mortality in the first year following STN-DBS. 29) Our series included two cases of attempted suicide. Both patients required psychiatric intervention and subsequently became emotionally stable.…”

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

“…There is evidence that DBS may also worsen depression and mania, increase apathy, affect emotional lability, and increase the risk of suicide (Berney et al, 2002;Doshi et al, 2002;Okun et al, 2003Okun et al, , 2009Funkiewiez et al, 2004;Smeding et al, 2005Smeding et al, , 2006Drapier et al, 2008;Voon et al, 2008). Mood problems are more common in patients treated with STN-DBS than those treated with GPi-DBS Follett et al, 2010;Moro et al, 2010;Bronstein et al, 2011).…”

Lack of functional relevance of isolated cell damage in transplants of Parkinson’s disease patients

“…1) [24,38,42]. DBS is also associated with a suicide risk after surgery [46]. Another important surgical approach is cellbased replacement therapy.…”