Abstract
Deep brain stimulation (DBS) has been approved by the FDA for use
in the treatment of Parkinson's disease, essential tremor, and dystonia.
Case reports and case series have reported significant psychiatric
side effects in some individuals. The goal of this meta-analysis
is to characterize the risks and benefits of DBS and to assess its
possible use within the psychiatric setting. A search was conducted
on PubMed, EBSCO, and PsycInfo in January 2006 that covered the time
period 1 Jan 1996-30 Dec 2005. All identified articles were reviewed
and those describing adverse events were further examined with a
structured instrument. The initial searches yielded 2667 citations;
808 articles met inclusion criteria for the meta-analysis; 98.2\%
of studies that specifically assessed motor function reported some
level of improvement. Most reported side effects were device or procedure
related (e.g., infection and lead fracture). The prevalence of depression
was 2-4\%, mania 0.9-1.7\%, emotional changes 0.1-0.2\%, and the
prevalence of suicidal ideation/suicide attempt was 0.3-0.7\%. The
completed suicide rate was 0.16-0.32\%. In conclusion, DBS is an
effective treatment for Parkinson's disease, dystonia, and essential
tremor, and case reports suggest that major depression and OCD may
also respond to DBS. Reported rates of depression, cognitive impairment,
mania, and behavior change are low, but there is a high rate of suicide
in patients treated with DBS, particularly with thalamic and GPi
stimulation. Because of the high suicide rate, patients should be
prescreened for suicide risk prior to DBS surgery. Additionally,
patients should be monitored closely for suicidal behavior post-operatively.
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