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

Valerie Voon, Paul Krack, Anthony E. Lang, Andres M. Lozano, Kathy Dujardin, Michael Schüpbach, James D’Ambrosia, Stephane Thobois, Filippo Tamma, Jan Herzog, Johannes D. Speelman, Johan Samanta, Cynthia Kubu, Helene Rossignol, Yu-Yan Poon, Jean A. Saint-Cyr, Claire Ardouin, Elena Moro
DOI: http://dx.doi.org/10.1093/brain/awn214 2720-2728 First published online: 21 October 2008

Summary

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.

  • suicide
  • deep brain stimulation
  • Parkinson's disease
  • depression
  • subthalamic stimulation
  • Abbreviations:
    Abbreviations:
    ICDs
    impulse control disorders
    LEDD
    Levodopa equivalent daily dose
    SMR
    standardized mortality ratio
    STN DBS
    subthalamic nucleus deep brain stimulation
    UPDRS
    Unified Parkinson's Disease Rating Scale
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