A double-blind evaluation of electroconvulsive therapy in Parkinson's disease with “on-off” phenomena

Abstract

Eleven patients with severe Parkinson's disease and on-off-phenomena were included in a controlled double-blind study on the effect of electroconvulsive therapy (ECT). Pharmacological treatment was optimally adjusted before the trial. The severity of extrapyramidal symptoms was measured before, during and after the treatment. The patients were randomly allocated into one group, receiving active ECT and another, receiving sham treatment. The patients given active ECT showed significantly (P less than 0.05) prolonged duration of "on"-phases after ECT, in comparison to the sham-treated group. When collecting data from the controlled part of the study and the subsequent with open administration of ECT, the treatment was in addition found to significantly decrease the time and number of steps required to walk 10 meters. Moreover it reduced the severity of parkinsonian symptoms according to the Webster scale. The improvement induced by ECT was generally short-lasting. Lumbar punctures were performed before and after ECT. The concentrations of monoamine metabolites in cerebrospinal fluid were not affected by the treatment. The results indicate that ECT has an antiparkinsonian effect which probably is mediated via changed responsiveness of dopamine receptors and that further improvement is possible in patients, therapy resistant to the presently available medication.

Depression in Parkinson’s Disease: Conceptual Issues and Clinical Challenges

“…74,75 Indeed, ECT has been tried as a treatment for motor symptoms in PD patients without depression, with apparent positive results, lasting from several weeks to months. [76][77][78] Looking at the limited number of studies, and their largely negative results, it is not surprising that 2 systematic reviews have concluded that there is insufficient evidence for the efficacy and safety of SSRIs and tricyclic antidepressants (TCAs) in the treatment of depression in PD, with the exception of a possible efficacy of nortriptyline. 79,80 The most important consequence of the high placeboresponse in the aforementioned double-blind studies is that studies that have not followed a placebo-controlled design will never provide evidence of a superior efficacy of antidepressant treatment.…”

Electroconvulsive therapy in Parkinson´s disease

“…Antidepressants and antipsychotics are considered the first-line of treatment for these neuropsychiatric symptoms. Electroconvulsive therapy should be considered for those with refractory symptoms or in whom serious side effects from drug therapy have developed 16 . ECT has been reported as a successful procedure for neuropsychiatric symptoms in patients with Parkinson's disease, including psychosis 11,17 , anxiety 18 , depression 19 and obsessive-compulsive disorder 20 .…”

Evidências da eficácia da eletroconvulsoterapia na prática psiquiátrica

“…The use of the technique in those conditions, however, is still not firmly established, once there is a lack of evidence to support indication in those cases. Only two RCT 37,38 were found about the use of ECT in Parkinson's disease and two RCT 19,37 and a systematic review 13 about tardive dyskinesia. These studies, which had a consistent design, could not prove the efficacy of ECT for such pathologies.…”