Electroconvulsive therapy for severe depression, psychosis and chorea in a patient with Huntington's disease: case report and review of the literature

Abstract

Aims and method The psychiatric manifestations of Huntington's disease are myriad and difficult to control. The use of electroconvulsive therapy (ECT) is not commonly considered for this condition. We describe a patient with severe depression, psychomotor retardation, delusions and weight loss who responded to ECT with good control of her symptoms. Results Both our case and the literature appear to confirm the efficacy of ECT in the treatment of depression in Huntington's disease and suggest that other psychiatric manifestations of Huntington's are also responsive. Clinical implications ECT is an effective and safe treatment that should be considered earlier in the course of the disease in cases that show limited response to pharmacological therapy. It should also be considered as an adjunct to medical therapy that may simplify polypharmacy and allow better control in patients with debilitating psychiatric manifestations of the disease. There is limited and conflicting evidence for its efficacy in chorea.

Electroconvulsive therapy in Huntington's disease

“…There was partial remission of the auditory hallucinations, which reduced in frequency and no longer distressed her. 8 She has remained stable with once fortnightly ECT. Her involuntary movements have also shown improvement.…”

“…Case report: Mowafi et al 2020 8 The authors document the case of a 64-year-old female who presented with worsening choreoathetoid movements, weight loss and deterioration in mood. 8 She required a short inpatient admission for fluids via a nasogastric tube. The involuntary movements had become refractory to tetrabenazine which was withdrawn because of depressive symptoms.…”

“…The hallucinations instructed her not to eat or drink and she also experienced delusions of guilt believing that she was undeserving of food. 8 The patient was started on twice weekly bilateral ECT aiming for seizure duration of 30-60 seconds. She received 12 treatments and the depressive symptoms improved.…”

“…The patient had a further 12 treatments biweekly and then maintenance ECT biweekly. 8 During the course of treatment she developed a lower respiratory tract infection that led to a relapse of her psychiatric symptoms. There was marked choreoathetosis and dyskinesia with tetrabenazine being restarted.…”

Neuropsychiatrische Störungen bei Chorea Huntington

“…Das Risiko für Depressionen bei Huntington-Erkrankten ist höher bei Frauen (OR 1,77) und wenn eine frühere depressive Episode (OR 5,57) vorhanden war [14,19]. Bei Therapieversagen wird die Elektrokonvulsionstherapie (EKT) empfohlen [13,24,25].…”