Psychiatric Outcomes in Parkinson's Disease Treated with Deep Brain Stimulation as Compared with Dystonia and Tremor
Kaitlyn Blake, Khoolod Ahmed, Papa Midley, Jesse Maynard, Elizabeth Beyene, Mekdem Bisrate, Miriam MichaelAbstract
Background Deep brain stimulation (DBS) has emerged as a transformative intervention for motor symptom control in patients with Parkinson's disease (PD). While its benefits are well-established, concerns persist regarding the potential exacerbation or emergence of psychiatric conditions—particularly depression, psychosis, and disinhibition—following DBS. Clarifying these risks is essential for comprehensive patient counseling and long-term management planning.
Methods Using the TriNetX Global Collaborative Network, we conducted a retrospective cohort study comparing psychiatric outcomes in PD patients with and without dystonia or tremors who underwent DBS. After 1:1 propensity score matching on demographics and baseline characteristics, each group included 10,200 patients. Psychiatric outcomes were assessed using risk ratios, Kaplan-Meier survival analysis, and Cox proportional hazards models.
Results Depression was the most prevalent psychiatric outcome, affecting approximately 24% of both groups. While risk ratios and survival curves showed no significant differences (relative risk [RR]: 0.98; hazard ratio [HR:] 1.08; p> 0.7), the dystonia/tremor (D/T) group exhibited a trend toward a higher frequency of recurrent depressive episodes (mean: 2.2 vs. 1.1; p = 0.09), although this difference was not statistically significant. Other outcomes—including disinhibition (2.3 vs. 2.1%), delirium (6.5 vs. 5.4%), euphoria (1.3% both), and psychosis (2.3 vs. 2.7%)—were rare and showed no meaningful differences in risk, frequency, or time of onset (all p> 0.3). Overall, Kaplan − Meier curves demonstrated no accelerated onset of psychiatric symptoms in the D/T group.
Conclusion In the setting of DBS in PD, these findings indicate that dystonia or tremor does not significantly alter psychiatric risk following DBS in PD. However, ongoing surveillance for depression is warranted as part of postoperative care.