Objective: This systematic review and meta-analysis was designed to evaluate risk factors and correlates of psychosis in PD after DBS surgery.

Background: Deep brain stimulation (DBS) shows good therapeutic benefits on the motor symptoms of Parkinson’s disease (PD); however, psychosis occurs in some patients with time. Risks factors for the development of psychotic symptoms after the surgery remains incompletely elucidated. Thus, we conducted a systematic review and meta-analysis of available evidence for a better understanding of factors associated with post-DBS psychosis.

Methods: We searched the PubMed, ScienceDirect, and ClinicalTrials.gov databases from inception through May 10th, 2017 and followed the guideline of meta-analysis of observational studies in epidemiology instruction.

Results: Twelve studies comprising 1037 participants with PD met inclusion criteria. The cross-sectional prevalence of post-DBS psychosis was positively associated with follow-up duration and higher stimulation frequency but inversely with a higher stimulation voltage. The person-year incidence of post-DBS psychosis was positively associated with lower pre-DBS UPDRS scores. In subgroup analysis, post-DBS psychosis was associated with longer follow-up duration. Incidence was lower in studies that employed standard diagnostic criteria for psychosis but higher in patients with baseline UPDRS scores <40 and levodopa-equivalent doses <1000mg. It was noted that gait disturbance and Hoenh and Yahr stage >=3 were not related to psychosis

Conclusions: A number of other findings may not have been predicted a priori and may be explicable by the complexities of DBS, including patient selection and management to attempt to reduce or treat psychosis. With early post-DBS psychosis, physicians tend to reduce the stimulating voltage but increase the stimulating frequency, which may be the reason for that prevalence of psychosis was positively associated with stimulating frequency but inversely related to the stimulating voltage. Lower dose of LEDD before or after the operation reflects that clinicians tend to reduce medication doses when patients exhibit psychotic symptoms. Those unexpected findings need to be confirmed in prospective studies.

References: 1. Constantinescu R, Eriksson B, Jansson Y, et al. Key clinical milestones 15 years and onwards after DBS-STN surgery-A retrospective analysis of patients that underwent surgery between 1993 and 2001. Clin Neurol Neurosurg 2017;154:43-48. 2. Castelli L, Perozzo P, Zibetti M, et al. Chronic deep brain stimulation of the subthalamic nucleus for Parkinson’s disease: effects on cognition, mood, anxiety and personality traits. Eur Neurol 2006;55(3):136-144. 3. Qureshi AA, Cheng JJ, Sunshine AN, et al. Postoperative symptoms of psychosis after deep brain stimulation in patients with Parkinson’s disease. Neurosurg Focus 2015;38(6):E5. 4. Voon V, Saint-Cyr J, Lozano AM, Moro E, Poon YY, Lang AE. Psychiatric symptoms in patients with Parkinson disease presenting for deep brain stimulation surgery. J Neurosurg 2005;103(2):246-251. 5. Cozac VV, Ehrensperger MM, Gschwandtner U, et al. Older Candidates for Subthalamic Deep Brain Stimulation in Parkinson’s Disease Have a Higher Incidence of Psychiatric Serious Adverse Events. Front Aging Neurosci 2016;8:132. 6. Boel JA, Odekerken VJ, Schmand BA, et al. Cognitive and psychiatric outcome 3 years after globus pallidus pars interna or subthalamic nucleus deep brain stimulation for Parkinson’s disease. Parkinsonism Relat Disord 2016;33:90-95. 7. Umemura A, Oka Y, Yamamoto K, Okita K, Matsukawa N, Yamada K. Complications of subthalamic nucleus stimulation in Parkinson’s disease. Neurol Med Chir (Tokyo) 2011;51(11):749-755. 8. Chopra A, Abulseoud OA, Sampson S, et al. Mood stability in Parkinson disease following deep brain stimulation: a 6-month prospective follow-up study. Psychosomatics 2014;55(5):478-484. 9. Welter ML, Schupbach M, Czernecki V, et al. Optimal target localization for subthalamic stimulation in patients with Parkinson disease. Neurology 2014;82(15):1352-1361. 10. Chen CC, Lee ST, Wu T, Chen CJ, Chen MC, Lu CS. Short-term effect of bilateral subthalamic stimulation for advanced Parkinson’s disease. Chang Gung Med J 2003;26(5):344-351. 11. Vesper J, Haak S, Ostertag C, Nikkhah G. Subthalamic nucleus deep brain stimulation in elderly patients–analysis of outcome and complications. BMC Neurol 2007;7:7. 12. Herzog J, Volkmann J, Krack P, et al. Two-year follow-up of subthalamic deep brain stimulation in Parkinson’s disease. Mov Disord 2003;18(11):1332-1337.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/post-deep-brain-stimulation-psychosis-in-parkinsons-disease-a-meta-analysis/