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Giannini G, Francois M, Lhommée E, Polosan M, Schmitt E, Fraix V, Castrioto A, Ardouin C, Bichon A, Pollak P, Benabid AL, Seigneuret E, Chabardes S, Wack M, Krack P, Moro E. Suicide and suicide attempts after subthalamic nucleus stimulation in Parkinson disease. Neurology 2019; 93:e97-e105. [PMID: 31101738 DOI: 10.1212/wnl.0000000000007665] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 02/18/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the postoperative attempted and completed suicide rates after subthalamic nucleus deep brain stimulation (STN-DBS) in a single-center cohort and to determine factors associated with attempted and completed suicide. METHODS We retrospectively included all patients with Parkinson disease (PD) who underwent bilateral STN-DBS surgery at the Grenoble University Hospital between 1993 and 2016. For each patient who committed or attempted suicide, 2 patients with PD with STN-DBS without any suicidal behaviors were matched for age (±1 year), sex, and year of surgery (±2 years). Clinical data were collected from medical records. Detailed preoperative and postoperative neuropsychological evaluations, including frontal and Beck Depression Inventory (BDI) scores, were gathered. RESULTS A total of 534 patients with PD were included. Completed and attempted suicide percentages were 0.75% (4 of 534) and 4.11% (22 of 534), respectively. The observed suicide rate in the first postoperative year (187.20 of 100,000 per year, 1 of 534) was higher than the expected National Observatory on Suicide Risks rate adjusted for age and sex (standardized mortality ratio 8.1). This rate remained similar over the second and third postoperative years. In a comparison of the 26 patients completing/attempting suicide and the 52 controls, the first group showed more frequent history of suicidal ideation/suicide attempts and psychotic symptoms, higher percentage of family psychiatric history, higher psychiatric medication use, and higher preoperative frontal and BDI scores on neuropsychological evaluations. CONCLUSIONS Suicide behaviors can occur after STN-DBS, especially during the first 3 years. A careful multidisciplinary assessment and long-term follow-up are recommended to recognize and treat this potentially preventable risk for mortality.
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Affiliation(s)
- Giulia Giannini
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Matthieu Francois
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Eugénie Lhommée
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Mircea Polosan
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Emmanuelle Schmitt
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Valérie Fraix
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Anna Castrioto
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Claire Ardouin
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Amélie Bichon
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Pierre Pollak
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Alim-Louis Benabid
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Eric Seigneuret
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Stephan Chabardes
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Maxime Wack
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Paul Krack
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Elena Moro
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France.
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