Suicide ideation and behaviours after STN and GPi DBS surgery for Parkinson’s disease: results from a randomised, controlled trial
- Daniel Weintraub1,2,3,
- John E Duda1,3,
- Kimberly Carlson4,
- Ping Luo4,
- Oren Sagher5,
- Matthew Stern1,3,
- Kenneth A Follett6,
- Domenic Reda4,
- Frances M Weaver7,8,
- for the CSP 468 Study Group
- 1Parkinson’s Disease, Research, Education and Clinical Center (PADRECC), Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA
- 2Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- 3Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- 4Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA
- 5Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
- 6Omaha VA Medical Center and Division of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
- 7Health Services Research Center, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois, USA
- 8Department of Medicine, Loyola University Stritch School of Medicine, Chicago, Illinois, USA
- Correspondence to Dr Daniel Weintraub, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia VA Medical Center, 3615 Chestnut St #330, Philadelphia, PA 19104, USA;
- Received 18 October 2012
- Revised 28 February 2013
- Accepted 9 April 2013
- Published Online First 10 May 2013
Background The risk of suicide behaviours post–deep brain stimulation (DBS) surgery in Parkinson’s disease (PD) remains controversial. We assessed if suicide ideation and behaviours are more common in PD patients (1) randomised to DBS surgery versus best medical therapy (BMT); and (2) randomised to subthalamic nucleus (STN) versus globus pallidus interna (GPi) DBS surgery.
Methods In Phase 1 of the Veterans Affairs CSP 468 study, 255 PD patients were randomised to DBS surgery (n=121) or 6 months of BMT (n=134). For Phase 2, a total of 299 patients were randomised to STN (n=147) or GPi (n=152) DBS surgery. Patients were assessed serially with the Unified Parkinson's Disease Rating Scale Part I depression item, which queries for suicide ideation; additionally, both suicide behaviour adverse event data and proxy symptoms of increased suicide risk from the Parkinson's Disease Questionnaire (PDQ-39) and the Short Form Health Survey (SF-36) were collected.
Results In Phase 1, no suicide behaviours were reported, and new-onset suicide ideation was rare (1.9% for DBS vs 0.9% for BMT; Fisher's exact p=0.61). Proxy symptoms of relevance to suicide ideation were similar in the two groups. Rates of suicide ideation at 6 months were similar for patients randomised to STN versus GPi DBS (1.5% vs 0.7%; Fisher's exact p=0.61), but several proxy symptoms were worse in the STN group.
Conclusions Results from the randomised, controlled phase of a DBS surgery study in PD patients do not support a direct association between DBS surgery and an increased risk for suicide ideation and behaviours.