Session Time: 1:45pm-3:15pm
Location: Hall 3FG
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.
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To cite this abstract in AMA style:YC. Tai, N. Mahant, B. Stubbs, A. Carvalho, YW. Chen, TY. Chen, SP. Hsu, PT. Tseng. Post-Deep Brain Stimulation Psychosis in Parkinson’s Disease: A Meta-analysis [abstract]. Mov Disord. 2018; 33 (suppl 2). https://www.mdsabstracts.org/abstract/post-deep-brain-stimulation-psychosis-in-parkinsons-disease-a-meta-analysis/. Accessed December 9, 2023.
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