A multicentre study on suicide outcomes following subthalamic stimulation for Parkinson's disease.
Valerie Voon,Valerie Voon,Paul Krack,Anthony E. Lang,Andres M. Lozano,Kathy Dujardin,Michael Schüpbach,James M. Dambrosia,Stéphane Thobois,Filippo Tamma,Jan Herzog,Johannes D. Speelman,Johan Samanta,Cynthia S. Kubu,Helene Rossignol,Yu-Yan Poon,Jean A. Saint-Cyr,Claire Ardouin,Elena Moro +18 more
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TLDR
The suicide rate following subthalamic nucleus deep brain stimulation for Parkinson's disease was determined by conducting an international multicentre retrospective survey of movement disorder and surgical centres and factors associated with suicide attempts through a nested case-control study.Abstract:
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.read more
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The Movement Disorder Society Evidence-Based Medicine Review Update: Treatments for the non-motor symptoms of Parkinson's disease
Klaus Seppi,Daniel Weintraub,Miguel Coelho,Santiago Perez-Lloret,Susan H. Fox,Regina Katzenschlager,Eva-Maria Hametner,Werner Poewe,Olivier Rascol,Christopher G. Goetz,Cristina Sampaio +10 more
TL;DR: The objective of this work was to update previous EBM reviews on treatments for PD with a focus on non‐motor symptoms and found that most of the other interventions there is insufficient evidence to make adequate conclusions on their efficacy.
Journal ArticleDOI
Neurostimulation for Parkinson's Disease with Early Motor Complications
W. M. M. Schuepbach,Jörn Rau,Karina Knudsen,Jens Volkmann,Paul Krack,Lars Timmermann,Thomas D. Hälbig,Helke Hesekamp,S. M. Navarro,Niklaus Meier,Daniela Falk,Maximilian Mehdorn,S. Paschen,Mohammad Maarouf,Michael T. Barbe,Gereon R. Fink,Andreas Kupsch,Doreen Gruber,G.-H. Schneider,Eric Seigneuret,Andrea Kistner,Patrick Chaynes,Fabienne Ory-Magne,C. Brefel Courbon,Jan Vesper,Alfons Schnitzler,Lars Wojtecki,Jean-Luc Houeto,Benoit Bataille,David Maltête,P. Damier,Sylvie Raoul,F. Sixel-Doering,D. Hellwig,Alireza Gharabaghi,Rejko Krüger,M. O. Pinsker,Florian Amtage,J. Regis,Tatiana Witjas,Stéphane Thobois,Patrick Mertens,Manja Kloss,Andreas Hartmann,Wolfgang H. Oertel,Bart Post,Hans Speelman,Yves Agid,Carmen Schade-Brittinger,Günther Deuschl +49 more
TL;DR: Subthalamic stimulation was superior to medical therapy in patients with Parkinson's disease and early motor complications and time with good mobility and no dyskinesia.
Journal ArticleDOI
Deep Brain Stimulation for Parkinson Disease: An Expert Consensus and Review of Key Issues
Jeff M. Bronstein,Michele Tagliati,Ron L. Alterman,Andres M. Lozano,Jens Volkmann,Alessandro Stefani,Fay B. Horak,Michael S. Okun,Kelly D. Foote,Paul Krack,Rajesh Pahwa,Jaimie M. Henderson,Marwan Hariz,Roy A.E. Bakay,Ali R. Rezai,William J. Marks,Elena Moro,Jerrold L. Vitek,Frances M. Weaver,Robert E. Gross,Mahlon R. DeLong +20 more
TL;DR: Recommendations are provided to patients, physicians, and other health care providers on several issues involving deep brain stimulation (DBS) for Parkinson disease (PD) to be considered in a select group of appropriate patients.
Journal ArticleDOI
Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson's disease (PD SURG trial): a randomised, open-label trial
Adrian J Williams,Steven R. Gill,T. R. K. Varma,Crispin Jenkinson,Niall Quinn,Rosalind Mitchell,Richard B. Scott,Natalie Ives,Caroline Rick,Jane P Daniels,Smitaa Patel,Keith Wheatley +11 more
TL;DR: At 1 year, surgery and best medical therapy improved patient self-reported quality of life more than best medical Therapy alone in patients with advanced Parkinson's disease, but surgery is not without risk and targeting of patients most likely to benefit might be warranted.
Journal ArticleDOI
Non-motor dopamine withdrawal syndrome after surgery for Parkinson's disease: predictors and underlying mesolimbic denervation
Stéphane Thobois,Claire Ardouin,Claire Ardouin,Eugénie Lhommée,Eugénie Lhommée,Hélène Klinger,Hélène Klinger,Christelle Lagrange,Christelle Lagrange,Jing Xie,Jing Xie,Valérie Fraix,Valérie Fraix,Maria Clara Coelho Braga,Rachid Hassani,Andrea Kistner,Andrea Kistner,Alexandra Juphard,Eric Seigneuret,Eric Seigneuret,Stephan Chabardes,Stephan Chabardes,Patrick Mertens,Gustavo Polo,Anthonin Reilhac,Nicolas Costes,Didier Lebars,Marc Savasta,Léon Tremblay,Jean-Louis Quesada,Jean-Luc Bosson,Alim-Louis Benabid,Emmanuel Broussolle,Emmanuel Broussolle,Pierre Pollak,Pierre Pollak,Paul Krack,Paul Krack +37 more
TL;DR: A prospective study of the occurrence of apathy and associated symptoms, predictors and mechanisms in the year following subthalamic stimulation in patients with Parkinson's disease, finding non-motor fluctuations are related to mesolimbic dopaminergic denervation.
References
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A Randomized Trial of Deep-Brain Stimulation for Parkinson's Disease
Günther Deuschl,Carmen Schade-Brittinger,Paul Krack,Jens Volkmann,Helmut Schäfer,Kai Bötzel,C. Daniels,Angela Deutschländer,Ulrich Dillmann,Wilhelm Eisner,Doreen Gruber,Wolfgang Hamel,Jan Herzog,Rüdiger Hilker,Stephan Klebe,Manja Kloss,J. Koy,Martin Krause,Andreas Kupsch,Delia Lorenz,Stefan Lorenzl,H. Maximilian Mehdorn,Jean Richard Moringlane,Wolfgang H. Oertel,Marcus O. Pinsker,Heinz Reichmann,Alexander Reuss,Gerd-Helge Schneider,Alfons Schnitzler,Ulrich Steude,Volker Sturm,Lars Timmermann,Volker M. Tronnier,Thomas Trottenberg,Lars Wojtecki,Elisabeth Wolf,Werner Poewe,Jürgen Voges +37 more
TL;DR: In this six-month study of patients under 75 years of age with severe motor complications of Parkinson's disease, neurostimulation of the subthalamic nucleus was more effective than medical management alone.
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Hold your horses: impulsivity, deep brain stimulation, and medication in parkinsonism.
TL;DR: It is shown that DBS selectively interferes with the normal ability to slow down when faced with decision conflict, which implicate independent mechanisms leading to impulsivity in treated Parkinson's patients and were predicted by a single neurocomputational model of the basal ganglia.
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Douglas E. Hobson,Anthony E. Lang,W.R. Wayne Martin,Ajmal Razmy,Jean Rivest,Jonathan Fleming +5 more
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