Electroconvulsive therapy in Parkinson´s disease

Abstract

Parkinson's disease (PD) is characterized by a wide spectrum of motor and non-motor features; the latter include a high prevalence of neuropsychiatric symptoms 1 . Depression and psychosis are among the most frequent neuropsychiatric symptoms in PD 2,3 . Depression and psychosis have been associated with poor health-related quality-of-life and disability 4,5,6 . Psychopharmacotherapy is currently considered the first-line of treatment for depression, as well as for psychosis in patients with PD. A recent meta-analysis on treatment for depression reported a moderate, but non-significant, pooled effect for antidepressants over placebo 7 , The rate of depression remission in PD is 37% to 44 8 . Regarding psychosis, response rates to antipsychotics have been reported to be complete in 33% and partial in another 33% of the cases 9,10 . In refractory cases, the use of electroconvulsive therapy (ECT) has been proved to have beneficial effects on both, neuropsychiatric symptoms and motor symptoms of patients with PD 11,12 . The majority of these studies are uncontrolled prospective or retrospective studies, or case reports. Moreover, the stigma surrounding ECT has may also account for a reduced use of it in the treatment of neuropsychiatric symptoms in subjects with PD.The objective of the present study is to analyze the effectiveness of electroconvulsive therapy for the management of depression and/or psychosis refractory to drug therapy in AbstrActObjective: To analyze the effectiveness of electroconvulsive therapy for the management of depression and/or psychosis refractory to drug therapy in patients with Parkinson disease. Method: A retrospective study was carried out including patients treated with electroconvulsive therapy during the period between 2002 and 2013. A review of the literature was performed. Results: A total of 27 patients were included. In regards to the neuropsychiatric diagnosis, 14 patients had major depression, 12 patients had both psychosis and depression, and only one patient had isolated psychosis. The mean number of electroconvulsive therapy sessions was 12 ± 2.8. After electroconvulsive therapy, all patients showed a statistically significant improvement in the Brief Psychiatric Rating scale (reduction of 52% points) and Hamilton Depression Rating Scale (reduction of 50% points) independent of the presence of psychosis, depression or both. Conclusion: Electroconvulsive therapy is effective for the treatment of refractory neuropsychiatric symptoms in Parkinson's disease.Keywords: Parkinson's disease, electroconvulsive therapy, psychosis, depression.rEsumo Objetivo: Analisar a eficácia da eletroconvulsoterapia para o tratamento da depressão e/ou psicoses refratária ao tratamento medicamentoso em pacientes com doença de Parkinson. Método: Um estudo retrospectivo foi realizado com pacientes tratados com a eletroconvulsoterapia, durante o período entre 2002 e 2013. Uma revisão da literatura foi realizada. Resultados: Um total de 27 pacientes foram incluídos. Em relação ao diagnóstico neuropsiqu...

Current treatment of behavioral and cognitive symptoms of Parkinson's disease

“…Electroconvulsive therapy (ECT) has not been studied in controlled trials, but recent case reports and case series suggest improvement in patients with PD and severe psychosis who did not respond to pharmacological treatments [126]. While ECT can improve motor symptoms of PD, it can also cause delirium in cognitively impaired patients [127,128].…”

Management of Psychosis in Parkinson’s Disease: Emphasizing Clinical Subtypes and Pathophysiological Mechanisms of the Condition

“…Electroconvulsive therapy has shown beneficial effects in the treatment of neuropsychiatric symptoms in PD in some studies in the literature. The most recently published study on the effect of ECT in 29 drug-refractory PD patients with psychiatric symptoms, 12 of them having psychosis and depression and one having isolated psychosis, showed an improvement in measures of motor as well as nonmotor function assessed by means of different scales as seen in Table 7 [ 137 ].…”

“… ECT: electroconvulsive therapy; SD: standard deviation; UPDRS: Unified Parkinson's Disease Rating Scale; HY: Hoehn and Yahr; MMSE: Mini Mental Status Examination; CGI: clinical global impression; BPRS: Brief Psychiatric Rating Scale; HDRS: Hamilton Depression Rating Scale; reference: Calderón-Fajardo et al, 2015 [ 137 ]. …”

“… NPI: neuropsychiatric inventory; HAM-D: Hamilton Depression Rating Scale; PANNS: Positive and Negative Syndrome Scale; SAPS: Scale for the Assessment of Positive Symptoms; BPRS: Brief Psychiatric Rating Scale; reference: Calderón-Fajardo et al, 2015 [ 137 ]. …”

Parkinson’s Disease Psychosis: Therapy Tips and the Importance of Communication Between Neurologists and Psychiatrists

“…Recent small retrospective and open-label studies have revealed significant improvements on psychiatric measurements and short-term improvements on motor symptoms of PD with the use of Electroconvulsive Therapy for PDP [72][73][74]. Although it could be used as a last resource, larger prospective clinical trials will be needed to confirm these results before widely recommending this therapy for cases of PDP.…”