Suicide after deep brain stimulation of the internal globus pallidus for dystonia

Abstract

Deep brain stimulation (DBS) of the internal globus pallidus (GPi) has been reported to be beneficial and safe in selected dystonias.1 Behavioral, mood, and cognitive adverse effects occur only rarely with DBS of the GPi regardless of the underlying movement disorder. This is in contrast with the growing evidence that DBS of the subthalamic nucleus in Parkinson disease may induce serious adverse changes in behavior and mood, including suicide.2 Here, we report that 2 of 16 patients in our pilot study of pallidal stimulation for dystonia committed suicide. Sixteen patients with dystonia (four cervical, two segmental, seven primary generalized, one secondary generalized, and two myoclonus–dystonia) underwent bilateral stimulation of the GPi from mid-2000 until 2005 at the Movement Disorders Department of the Academic Medical Center, University Hospital of Amsterdam. The procedure for DBS is a one-stage bilateral stereotactic approach using microrecording (in half of the patients) and macrostimulation to define the exact GPi target. Postoperatively the lead position was determined by means of fusion of the postoperative CT scan and the preoperative MRI scan of the brain.3 The mean follow-up period ranged from 3 weeks to 57 months. Standard rating scales for dystonia were used, but for the purpose of this article the clinical effect on dystonia was rated as minimal, moderate, and excellent improvement. Patient …