Electroconvulsive Therapy for Parkinson's Disease: A Systematic Review and Meta‐Analysis

Abstract

Background Electroconvulsive therapy (ECT) is a well‐established treatment for psychiatric disorders, including depression and psychosis. ECT has been reported to be effective in treating such psychiatric symptoms in patients with Parkinson's disease (PD) and has been also reported to be effective in treating motor symptoms. The aim of the study is to summarize previous clinical studies investigating the efficacy of ECT for symptoms in patients with PD. Methods A systematic review and meta‐analysis of any study designs assessing motor and/or non‐motor symptoms in patients with PD before and after ECT. Co‐primary outcomes were set as motor manifestations assessed using the Unified Parkinson's Disease Rating Scale or other rating scales, and non‐motor symptoms included depression and psychosis. Secondary outcomes were wearing‐off phenomenon and cognitive function. The impact of ECT on those symptoms was examined by comparing the severity of the symptoms before and after ECT using a random effect model and was expressed in standardized mean difference. Results Of 1219 identified citations, 14 studies (n = 129; 1 randomized controlled study, 9 prospective observational studies, and 4 retrospective studies) were analyzed. The findings were as follows: ECT significantly improved motor manifestations in patients with PD, and the improvement was significant in the subpopulation without psychiatric symptoms; ECT significantly improved depression and psychosis; and ECT significantly relieved wearing‐off phenomenon and did not worsen cognitive functioning. Conclusion The current meta‐analysis suggests the potential benefit of ECT on motor and non‐motor symptoms in presumably complicated and difficult‐to‐treat subgroups. © 2020 International Parkinson and Movement Disorder Society

Emerging Perspectives in the Diagnosis and Management of Depression and Psychosis in Parkinson's Disease

“…They also demonstrated that ECT did not decrease cognitive functioning, and decreased the 'wearing-off' phenomenon associated with levodopa. 48 Borisovskaya et al also conducted a meta-analysis of 116 case reports, which supported Takamiya's findings. 49 Despite the conclusions from these studies, ECT is not readily given as treatment, seemingly due to stigma, patient hesitancy and the transient confusion and delirium that occur in up to 33% of patients with PD who undergo ECT.…”

Risk Assessment of Electroconvulsive Therapy in Clinical Routine: A 3-Year Analysis of Life-Threatening Events in More Than 3,000 Treatment Sessions

“…These remarkable efficacy data of ECT were mainly found in the predominant indication of therapy-resistant depression and have stimulated ECT to be used successfully in a variety of mental and neurological disorders such as first-episode schizophrenia ( Grover et al, 2019 ), acute mania ( Zhang et al, 2021 ), during the early stages of antidepressive treatment ( Haq et al, 2015 ; van Diermen et al, 2018 ), for motor and behavioral symptoms of Parkinson’s disease ( Takamiya et al, 2021 ), and for sustaining mood improvement in geriatric depression ( Kellner et al, 2016 ). Furthermore, ECT is particularly effective in patients with depression, including psychotic features and elderly people with depression ( van Diermen et al, 2018 ), to be beneficial as an augmenting strategy in treatment-resistant schizophrenia ( Grover et al, 2019 ; Sinclair et al, 2019 ; Chiu et al, 2020 ) with maintenance ECT providing an effective form of relapse prevention ( Ward et al, 2018 ), in mania ( Elias et al, 2021 ), catatonia ( Kellner et al, 2020 ), severe agitation ( Grover et al, 2019 ), specific mental disorders in multiple sclerosis ( Yahya and Khawaja, 2021 ), and prepartum and postpartum psychotic states ( Gazdag et al, 2009 ).…”

Mood Disorders and Anxiety in Parkinson’s Disease: Current Concepts

“…67 A more recent meta-analysis by Takamiya et al corroborated these findings, revealing a statistically significant effect size of ECT on depression in PD patients with improvement of motor symptoms in patients both with and without psychiatric symptoms. 68 In spite of its apparent efficacy, ECT remains a scarcely used treatment modality for PD-related depression. Aversion to ECT appears to be multifactorial; contributing factors likely include the persistent stigma surrounding ECT, the inability to predict individual treatment outcomes with correspondingly variable need for maintenance ECT, and intolerability to the transient side effects (e.g., confusion, delirium) that occur in up to a third of PD patients.…”

“…66,67 The fear of impaired neurocognitive function after ECT may also contribute to the paucity of ECT use, although this is an uncommon consequence of ECT in PD patients. 67 -69…”