In patients with Parkinson disease (PD) who receive subthalamic nucleus deep brain stimulation (STN-DBS), suicide behaviors tend to occur during the first 3 years after the procedure, according to a study published in Neurology.
Patients with PD who underwent bilateral STN-DBS at a single center in France between 1993 and 2016 were included in the retrospective study (n=534). Medical records were used to collect data. Researchers matched every patient who completed (0.75%) or attempted (4.11%) suicide to 2 patients with PD who underwent STN-DBS and did not have any accompanying suicide behaviors by age, sex, and year of intervention. Neuro-psychological evaluation data, including those obtained from the frontal and Beck Depression Inventory scores, were gathered and compared from the pre- and postoperative periods.
In an analysis adjusted for age and sex, the observed suicide rate in the cohort (187.20 of 100,000 per year) during the first year after STN-DBS was higher than the expected National Observatory on Suicide Risks rate (23.10 of 100,000 per year). The postoperative suicide rate remained stable during the second and third years after the procedure. Compared with the 52 control patients, the 26 patients who completed or attempted suicide demonstrated a more frequent history of suicidal ideation/suicide attempts (5.76% vs 42.31%, respectively; P =.00018) and psychotic symptoms (11.53% vs 38.46%, respectively; P =.013), and a higher percentage of family psychiatric history (0.0% vs 15.4%, respectively; P =.01), and psychotropic medication use (40.4% vs 73.1%, respectively; P =.013). Those who attempted/completed suicide also had higher preoperative frontal scores (41.87 vs 37.41; P =.011) and Beck Depression Inventory scores (15.90 vs 10.44; P =.012).
Limitations of the study include the retrospective design, lack of a nonsurgical control group, and small number of participants in each group.
On the basis of their findings, the researchers suggest “clinicians should actively investigate suicidal ideation and pay more attention to a history of psychiatric issues and, in particular, of suicidal ideation/suicide attempts, verbalized suicidal ideation, preoperative depression, and psychotropic treatment use” in patients with PD scheduled to undergo STN-DBS.
Giannini G, Francois M, Lhommée E, et al. Suicide and suicide attempts after subthalamic nucleus stimulation in Parkinson disease [published online May 17, 2019]. Neurology. doi:10.1212/WNL.0000000000007665