title: Suicide ideation and behaviours after STN and GPi DBS surgery for Parkinson's disease: results from a randomised, controlled trial.
abstract: 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.
authors.affiliation: Parkinson's Disease, Research, Education and Clinical Center (PADRECC), Philadelphia VA Medical Center, Philadelphia, PA, USA. daniel.weintraub@uphs.upenn.edu
authors.forename: Daniel
authors.initials: D
authors.lastname: Weintraub
authors.forename: John E
authors.initials: JE
authors.lastname: Duda
authors.forename: Kimberly
authors.initials: K
authors.lastname: Carlson
authors.forename: Ping
authors.initials: P
authors.lastname: Luo
authors.forename: Oren
authors.initials: O
authors.lastname: Sagher
authors.forename: Matthew
authors.initials: M
authors.lastname: Stern
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Follett
authors.forename: Domenic
authors.initials: D
authors.lastname: Reda
authors.forename: Frances M
authors.initials: FM
authors.lastname: Weaver
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation; D003866:Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology*; D013406:Suicide, Attempted / Q000523:psychology*
keywords: BEHAVIOURAL DISORDER; PARKINSON'S DISEASE; SURGERY