Suicide ideation and behaviours after STN and GPi DBS surgery for Parkinson’s disease: results from a randomised, controlled trial
Identifieur interne : 002808 ( Main/Corpus ); précédent : 002807; suivant : 002809Suicide ideation and behaviours after STN and GPi DBS surgery for Parkinson’s disease: results from a randomised, controlled trial
Auteurs : Daniel Weintraub ; John E. Duda ; Kimberly Carlson ; Ping Luo ; Oren Sagher ; Matthew Stern ; Kenneth A. Follett ; Domenic Reda ; Frances M. WeaverSource :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2013-10.
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.
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DOI: 10.1136/jnnp-2012-304396
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Duda</name><affiliation><mods:affiliation>Parkinson’s Disease, Research, Education and Clinical Center (PADRECC), Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</mods:affiliation></affiliation></author><author><name sortKey="Carlson, Kimberly" sort="Carlson, Kimberly" uniqKey="Carlson K" first="Kimberly" last="Carlson">Kimberly Carlson</name><affiliation><mods:affiliation>Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA</mods:affiliation></affiliation></author><author><name sortKey="Luo, Ping" sort="Luo, Ping" uniqKey="Luo P" first="Ping" last="Luo">Ping Luo</name><affiliation><mods:affiliation>Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA</mods:affiliation></affiliation></author><author><name sortKey="Sagher, Oren" sort="Sagher, Oren" uniqKey="Sagher O" first="Oren" last="Sagher">Oren Sagher</name><affiliation><mods:affiliation>Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan, USA</mods:affiliation></affiliation></author><author><name sortKey="Stern, Matthew" sort="Stern, Matthew" uniqKey="Stern M" first="Matthew" last="Stern">Matthew Stern</name><affiliation><mods:affiliation>Parkinson’s Disease, Research, Education and Clinical Center (PADRECC), Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</mods:affiliation></affiliation></author><author><name sortKey="Follett, Kenneth A" sort="Follett, Kenneth A" uniqKey="Follett K" first="Kenneth A" last="Follett">Kenneth A. 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Duda</name><affiliation><mods:affiliation>Parkinson’s Disease, Research, Education and Clinical Center (PADRECC), Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</mods:affiliation></affiliation></author><author><name sortKey="Carlson, Kimberly" sort="Carlson, Kimberly" uniqKey="Carlson K" first="Kimberly" last="Carlson">Kimberly Carlson</name><affiliation><mods:affiliation>Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA</mods:affiliation></affiliation></author><author><name sortKey="Luo, Ping" sort="Luo, Ping" uniqKey="Luo P" first="Ping" last="Luo">Ping Luo</name><affiliation><mods:affiliation>Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA</mods:affiliation></affiliation></author><author><name sortKey="Sagher, Oren" sort="Sagher, Oren" uniqKey="Sagher O" first="Oren" last="Sagher">Oren Sagher</name><affiliation><mods:affiliation>Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan, USA</mods:affiliation></affiliation></author><author><name sortKey="Stern, Matthew" sort="Stern, Matthew" uniqKey="Stern M" first="Matthew" last="Stern">Matthew Stern</name><affiliation><mods:affiliation>Parkinson’s Disease, Research, Education and Clinical Center (PADRECC), Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</mods:affiliation></affiliation></author><author><name sortKey="Follett, Kenneth A" sort="Follett, Kenneth A" uniqKey="Follett K" first="Kenneth A" last="Follett">Kenneth A. Follett</name><affiliation><mods:affiliation>Omaha VA Medical Center and Division of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska, USA</mods:affiliation></affiliation></author><author><name sortKey="Reda, Domenic" sort="Reda, Domenic" uniqKey="Reda D" first="Domenic" last="Reda">Domenic Reda</name><affiliation><mods:affiliation>Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA</mods:affiliation></affiliation></author><author><name sortKey="Weaver, Frances M" sort="Weaver, Frances M" uniqKey="Weaver F" first="Frances M" last="Weaver">Frances M. Weaver</name><affiliation><mods:affiliation>Health Services Research Center, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Medicine, Loyola University Stritch School of Medicine, Chicago, Illinois, USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="ISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2013-10">2013-10</date><biblScope unit="volume">84</biblScope><biblScope unit="issue">10</biblScope><biblScope unit="page" from="1113">1113</biblScope></imprint><idno type="ISSN">0022-3050</idno></series><idno type="istex">4985FBC823D0321D8E7DB4FCC56C8E92767387BA</idno><idno type="DOI">10.1136/jnnp-2012-304396</idno><idno type="href">jnnp-84-1113.pdf</idno><idno type="ArticleID">jnnp-2012-304396</idno><idno type="PMID">23667214</idno><idno type="local">jnnp;84/10/1113</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3050</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="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.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>Daniel Weintraub</name><affiliations><json:string>Parkinson’s Disease, Research, Education and Clinical Center (PADRECC), Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA</json:string><json:string>Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</json:string><json:string>Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</json:string></affiliations></json:item><json:item><name>John E Duda</name><affiliations><json:string>Parkinson’s Disease, Research, Education and Clinical Center (PADRECC), Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA</json:string><json:string>Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</json:string></affiliations></json:item><json:item><name>Kimberly Carlson</name><affiliations><json:string>Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA</json:string></affiliations></json:item><json:item><name>Ping Luo</name><affiliations><json:string>Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA</json:string></affiliations></json:item><json:item><name>Oren Sagher</name><affiliations><json:string>Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan, USA</json:string></affiliations></json:item><json:item><name>Matthew Stern</name><affiliations><json:string>Parkinson’s Disease, Research, Education and Clinical Center (PADRECC), Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA</json:string><json:string>Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</json:string></affiliations></json:item><json:item><name>Kenneth A Follett</name><affiliations><json:string>Omaha VA Medical Center and Division of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska, USA</json:string></affiliations></json:item><json:item><name>Domenic Reda</name><affiliations><json:string>Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA</json:string></affiliations></json:item><json:item><name>Frances M Weaver</name><affiliations><json:string>Health Services Research Center, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois, USA</json:string><json:string>Department of Medicine, Loyola University Stritch School of Medicine, Chicago, Illinois, USA</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Movement disorders</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>PARKINSON'S DISEASE</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>BEHAVIOURAL DISORDER</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>SURGERY</value></json:item></subject><language><json:string>eng</json:string></language><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.</abstract><qualityIndicators><score>7.69</score><pdfVersion>1.3</pdfVersion><pdfPageSize>595.276 x 793.701 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>4</keywordCount><abstractCharCount>1599</abstractCharCount><pdfWordCount>4702</pdfWordCount><pdfCharCount>31430</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>249</abstractWordCount></qualityIndicators><title>Suicide ideation and behaviours after STN and GPi DBS surgery for Parkinson’s disease: results from a randomised, controlled trial</title><pmid><json:string>23667214</json:string></pmid><corporate><json:item><name>for the CSP 468 Study 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Psychiatry</title></host><publicationDate>2013</publicationDate><copyrightDate>2013</copyrightDate><doi><json:string>10.1136/jnnp-2012-304396</json:string></doi><id>4985FBC823D0321D8E7DB4FCC56C8E92767387BA</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/4985FBC823D0321D8E7DB4FCC56C8E92767387BA/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/4985FBC823D0321D8E7DB4FCC56C8E92767387BA/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/4985FBC823D0321D8E7DB4FCC56C8E92767387BA/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Suicide ideation and behaviours after STN and GPi DBS surgery for Parkinson’s disease: results from a randomised, controlled trial</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>BMJ Publishing Group Ltd</publisher><availability><p>BMJ</p></availability><date>2013-05-10</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Suicide ideation and behaviours after STN and GPi DBS surgery for Parkinson’s disease: results from a randomised, controlled trial</title><author><orgName>for the CSP 468 Study Group</orgName></author><author><persName><forename type="first">Daniel</forename><surname>Weintraub</surname></persName><affiliation>Parkinson’s Disease, Research, Education and Clinical Center (PADRECC), Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA</affiliation><affiliation>Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</affiliation><affiliation>Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</affiliation></author><author><persName><forename type="first">John E</forename><surname>Duda</surname></persName><affiliation>Parkinson’s Disease, Research, Education and Clinical Center (PADRECC), Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA</affiliation><affiliation>Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</affiliation></author><author><persName><forename type="first">Kimberly</forename><surname>Carlson</surname></persName><affiliation>Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA</affiliation></author><author><persName><forename type="first">Ping</forename><surname>Luo</surname></persName><affiliation>Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA</affiliation></author><author><persName><forename type="first">Oren</forename><surname>Sagher</surname></persName><affiliation>Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan, USA</affiliation></author><author><persName><forename type="first">Matthew</forename><surname>Stern</surname></persName><affiliation>Parkinson’s Disease, Research, Education and Clinical Center (PADRECC), Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA</affiliation><affiliation>Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</affiliation></author><author><persName><forename type="first">Kenneth A</forename><surname>Follett</surname></persName><affiliation>Omaha VA Medical Center and Division of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska, USA</affiliation></author><author><persName><forename type="first">Domenic</forename><surname>Reda</surname></persName><affiliation>Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA</affiliation></author><author><persName><forename type="first">Frances M</forename><surname>Weaver</surname></persName><affiliation>Health Services Research Center, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois, USA</affiliation><affiliation>Department of Medicine, Loyola University Stritch School of Medicine, Chicago, Illinois, USA</affiliation></author></analytic><monogr><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="pISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2013-10"></date><biblScope unit="volume">84</biblScope><biblScope unit="issue">10</biblScope><biblScope unit="page" from="1113">1113</biblScope></imprint></monogr><idno type="istex">4985FBC823D0321D8E7DB4FCC56C8E92767387BA</idno><idno type="DOI">10.1136/jnnp-2012-304396</idno><idno type="href">jnnp-84-1113.pdf</idno><idno type="ArticleID">jnnp-2012-304396</idno><idno type="PMID">23667214</idno><idno type="local">jnnp;84/10/1113</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2013-05-10</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>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.</p></abstract><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>PARKINSON'S DISEASE</term></item><item><term>BEHAVIOURAL DISORDER</term></item><item><term>SURGERY</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2013-05-10">Created</change><change when="2013-10">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/4985FBC823D0321D8E7DB4FCC56C8E92767387BA/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">jnnp</journal-id><journal-id journal-id-type="nlm-ta">J Neurol Neurosurg Psychiatry</journal-id><journal-id journal-id-type="publisher-id">jnnp</journal-id><journal-title>Journal of Neurology, Neurosurgery & Psychiatry</journal-title><abbrev-journal-title abbrev-type="publisher">J Neurol Neurosurg Psychiatry</abbrev-journal-title><abbrev-journal-title>J Neurol Neurosurg Psychiatry</abbrev-journal-title><issn pub-type="ppub">0022-3050</issn><issn pub-type="epub">1468-330X</issn><publisher><publisher-name>BMJ Publishing Group Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">jnnp-2012-304396</article-id><article-id pub-id-type="doi">10.1136/jnnp-2012-304396</article-id><article-id pub-id-type="other">jnnp;84/10/1113</article-id><article-id pub-id-type="other">jnnp;jnnp-2012-304396</article-id><article-id pub-id-type="pmid">23667214</article-id><article-id pub-id-type="other">1113</article-id><article-id pub-id-type="other">jnnp-2012-304396</article-id><article-categories><subj-group subj-group-type="heading"><subject>Movement disorders</subject></subj-group><series-title>Research paper</series-title></article-categories><title-group><article-title>Suicide ideation and behaviours after STN and GPi DBS surgery for Parkinson’s disease: results from a randomised, controlled trial </article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Weintraub</surname><given-names>Daniel</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="aff" rid="af2">2</xref><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Duda</surname><given-names>John E</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Carlson</surname><given-names>Kimberly</given-names></name><xref ref-type="aff" rid="af4">4</xref></contrib><contrib contrib-type="author"><name><surname>Luo</surname><given-names>Ping</given-names></name><xref ref-type="aff" rid="af4">4</xref></contrib><contrib contrib-type="author"><name><surname>Sagher</surname><given-names>Oren</given-names></name><xref ref-type="aff" rid="af5">5</xref></contrib><contrib contrib-type="author"><name><surname>Stern</surname><given-names>Matthew</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Follett</surname><given-names>Kenneth A</given-names></name><xref ref-type="aff" rid="af6">6</xref></contrib><contrib contrib-type="author"><name><surname>Reda</surname><given-names>Domenic</given-names></name><xref ref-type="aff" rid="af4">4</xref></contrib><contrib contrib-type="author"><name><surname>Weaver</surname><given-names>Frances M</given-names></name><xref ref-type="aff" rid="af7">7</xref><xref ref-type="aff" rid="af8">8</xref></contrib><contrib contrib-type="author"><collab>for the CSP 468 Study Group</collab></contrib></contrib-group><aff id="af1"><label>1</label><addr-line>Parkinson’s Disease, Research, Education and Clinical Center (PADRECC), Philadelphia VA Medical Center, Philadelphia, Pennsylvania</addr-line>, <country>USA</country></aff><aff id="af2"><label>2</label><addr-line>Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania</addr-line>, <country>USA</country></aff><aff id="af3"><label>3</label><institution>Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania</institution>, <country>USA</country></aff><aff id="af4"><label>4</label><addr-line>Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois</addr-line>, <country>USA</country></aff><aff id="af5"><label>5</label><addr-line>Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan</addr-line>, <country>USA</country></aff><aff id="af6"><label>6</label><addr-line>Omaha VA Medical Center and Division of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska</addr-line>, <country>USA</country></aff><aff id="af7"><label>7</label><addr-line>Health Services Research Center, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois</addr-line>, <country>USA</country></aff><aff id="af8"><label>8</label><addr-line>Department of Medicine, Loyola University Stritch School of Medicine, Chicago, Illinois</addr-line>, <country>USA</country></aff><author-notes><corresp><label>Correspondence to</label> 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; <email>daniel.weintraub@uphs.upenn.edu</email></corresp></author-notes><pub-date pub-type="ppub"><month>10</month><year>2013</year></pub-date><pub-date pub-type="epub-original"><day>10</day><month>5</month><year>2013</year></pub-date><pub-date pub-type="epub"><day>10</day><month>5</month><year>2013</year></pub-date><volume>84</volume><volume-id pub-id-type="other">84</volume-id><volume-id pub-id-type="other">84</volume-id><issue>10</issue><issue-id pub-id-type="other">jnnp;84/10</issue-id><issue-id pub-id-type="other">10</issue-id><issue-id pub-id-type="other">84/10</issue-id><fpage>1113</fpage><history><date date-type="received"><day>18</day><month>10</month><year>2012</year></date><date date-type="rev-recd"><day>28</day><month>2</month><year>2013</year></date><date date-type="accepted"><day>9</day><month>4</month><year>2013</year></date></history><permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</copyright-statement><copyright-year>2013</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="jnnp-84-1113.pdf"></self-uri><abstract><sec><title>Background</title><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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.</p></sec><sec><title>Conclusions</title><p>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.</p></sec></abstract><kwd-group><kwd>PARKINSON'S DISEASE</kwd><kwd>BEHAVIOURAL DISORDER</kwd><kwd>SURGERY</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><partName>Research paper</partName><title>Suicide ideation and behaviours after STN and GPi DBS surgery for Parkinson’s disease: results from a randomised, controlled trial</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><partName>Research paper</partName><title>Suicide ideation and behaviours after STN and GPi DBS surgery for Parkinson’s disease: results from a randomised, controlled trial</title></titleInfo><name type="corporate"><namePart>for the CSP 468 Study Group</namePart></name><name type="personal"><namePart type="given">Daniel</namePart><namePart type="family">Weintraub</namePart><affiliation>Parkinson’s Disease, Research, Education and Clinical Center (PADRECC), Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA</affiliation><affiliation>Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</affiliation><affiliation>Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">John E</namePart><namePart type="family">Duda</namePart><affiliation>Parkinson’s Disease, Research, Education and Clinical Center (PADRECC), Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA</affiliation><affiliation>Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Kimberly</namePart><namePart type="family">Carlson</namePart><affiliation>Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ping</namePart><namePart type="family">Luo</namePart><affiliation>Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Oren</namePart><namePart type="family">Sagher</namePart><affiliation>Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Matthew</namePart><namePart type="family">Stern</namePart><affiliation>Parkinson’s Disease, Research, Education and Clinical Center (PADRECC), Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA</affiliation><affiliation>Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Kenneth A</namePart><namePart type="family">Follett</namePart><affiliation>Omaha VA Medical Center and Division of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Domenic</namePart><namePart type="family">Reda</namePart><affiliation>Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Frances M</namePart><namePart type="family">Weaver</namePart><affiliation>Health Services Research Center, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois, USA</affiliation><affiliation>Department of Medicine, Loyola University Stritch School of Medicine, Chicago, Illinois, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>BMJ Publishing Group Ltd</publisher><dateIssued encoding="w3cdtf">2013-10</dateIssued><dateCreated encoding="w3cdtf">2013-05-10</dateCreated><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><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.</abstract><subject><genre>Keywords</genre><topic>PARKINSON'S DISEASE</topic><topic>BEHAVIOURAL DISORDER</topic><topic>SURGERY</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Neurology, Neurosurgery & Psychiatry</title></titleInfo><titleInfo type="abbreviated"><title>J Neurol Neurosurg Psychiatry</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">0022-3050</identifier><identifier type="eISSN">1468-330X</identifier><identifier type="PublisherID">jnnp</identifier><identifier type="PublisherID-hwp">jnnp</identifier><identifier type="PublisherID-nlm-ta">J Neurol Neurosurg Psychiatry</identifier><part><date>2013</date><detail type="volume"><caption>vol.</caption><number>84</number></detail><detail type="issue"><caption>no.</caption><number>10</number></detail><extent unit="pages"><start>1113</start></extent></part></relatedItem><identifier type="istex">4985FBC823D0321D8E7DB4FCC56C8E92767387BA</identifier><identifier type="DOI">10.1136/jnnp-2012-304396</identifier><identifier type="href">jnnp-84-1113.pdf</identifier><identifier type="ArticleID">jnnp-2012-304396</identifier><identifier type="PMID">23667214</identifier><identifier type="local">jnnp;84/10/1113</identifier><accessCondition type="use and reproduction" contentType="copyright">Published by the BMJ Publishing Group Limited. 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