These are selected abstracts on the use of ElectroConvulsive
Therapy (ECT) in Parkinson's disease and Parkinson's Plus
Syndromes for various indications.


Unique Identifier
  96212560
Authors
  Barclay CL.  Duff J.  Sandor P.  Lang AE.
Title
  Limited usefulness of electroconvulsive therapy in progressive
  supranuclear palsy.
Source
  Neurology.  46(5):1284-6, 1996 May.
Abstract
  OBJECTIVE: To perform a pilot study of the efficacy of
electroconvulsive therapy (ECT) in improving motor function in
progressive supranuclear palsy (PSP). BACKGROUND: Few effective
treatments are available for PSP. Tricyclic antidepressants and
idazoxan (which increases central norepinephrine) have shown
benefits in small clinical trials, and dopaminergic therapy has
been reported, anecdotally, to be beneficial. ECT exerts effects
on all of these transmitter systems, possibly by inducing
increased receptor sensitivity. We postulated that by
sensitizing dopaminergic and noradrenergic systems, ECT might
improve motor symptoms of PSP. METHODS: Five patients with
clinically diagnosed PSP were evaluated before and after nine
ECT treatments using the Unified Parkinson's Disease Rating
Scale (UPDRS) and an apomorphine challenge to assess
dopaminergic responsiveness. RESULTS: No permanent side effects
were seen. Transient side effects included confusion in all
patients, worsening of speech and swallowing in two, and
dystonic posturing of the foot in one. One patient experienced a
dramatic response (going from a completely wheelchair-bound
state to independent ambulation), two were mildly improved, and
two were unchanged. CONCLUSIONS: Although ECT may ameliorate
motor symptoms in PSP, the long hospitalization and the
significant treatment-induced confusion limit the usefulness of
this technique.


Unique Identifier
  96076000
Authors
  Factor SA.  Molho ES.  Brown DL.
Title
  Combined clozapine and electroconvulsive therapy for the
treatment of drug-induced psychosis in Parkinson's disease.
Source Journal of Neuropsychiatry & Clinical Neurosciences.
7(3):304-7, 1995 Summer. Abstract Drug-induced psychosis is a
serious late complication of Parkinson's disease (PD) that
requires aggressive treatment. Recent studies have found
clozapine a highly effective and ECT a possibly useful
intervention. Two cases are presented that illustrate a possible
treatment role for ECT. The cases demonstrate that ECT has
significant but short-lived antipsychotic effects when used
alone. However, patients who do not respond to clozapine
monotherapy can be given adjunctive treatment with ECT. The
combination therapy resulted in abrupt alleviation of psychotic
symptoms in one of the cases, and maintenance with low-dose
clozapine allowed for long-term efficacy. On the basis of these
findings, a therapeutic approach to patients with drug-induced
psychosis in PD is suggested.


Unique Identifier
  95303178
Authors
  Folkerts H.
Title
  [Electroconvulsive therapy in neurologic diseases]. [Review]
[German] Source Nervenarzt.  66(4):241-51, 1995 Apr.
Abstract Numerous developments have improved the safety and
efficacy of electroconvulsive therapy (ECT) in recent years, so
that ECT is now one of the safest forms of treatment under
anesthesia. The indications for psychiatric patients are clearly
defined. ECT is also under discussion with respect to certain
neurological disorders. This discussion has, however, been
largely ignored by the German medical profession. Critical
evaluation of previous experience, especially in the United
States and in Scandinavia, reveals some clinical situations (e.g.
, akinetic crisis in Parkinson's disease) in which a primary
neurological indication for ECT might be present. ECT is
frequently indicated in other brain diseases if pronounced
psychopathological disturbances (especially of a depressive
type) occur and fail to respond to conventional treatment with
psychotropic drugs. ECT may then be indicated on a case-by-case
basis. ECT should not be withheld from such patients; on the
other hand, there is the risk of uncontrolled expansion of these
indications for ECT. [References: 108]


Unique Identifier
  95176970
Authors
  Factor SA.  Molho ES.  Podskalny GD.  Brown D.
Title
  Parkinson's disease: drug-induced psychiatric states. [Review]
Source
  Advances in Neurology.  65:115-38, 1995.
Abstract
  Drug-induced psychiatric states occur frequently in PD. In the
prelevodopa era, depression and other psychiatric disorders were
described in PD, but in untreated patients psychosis was rare.
Since the development of levodopa and other pharmacological
treatments for PD, however, psychotic symptoms have become much
more common (10-50%). In some individuals these problems can be
more disabling than the motor features of PD and, as a result,
pose a serious threat to the patient's ability to maintain
independence. The drug-induced psychoses consist of several
distinct psychiatric syndromes that can be divided broadly into
those occurring on a background of a clear sensorium and those
which are accompanied by confusion and clouding of consciousness.
 Benign organic hallucinosis is the most common of these
syndromes (30%). It usually occurs on a background of a clear
sensorium and may not be a particularly troublesome problem if
the patient is able to retain insight into the nature of these
symptoms. More disabling syndromes usually include delusional
thinking that is frequently paranoid, confusion and even frank
delirium. Although all these psychotic syndromes can occur in
isolation, there is a tendency for mild symptoms to progress to
more disabling ones if adequate and timely treatment is not
instituted. Abnormal dreaming and sleep disruption often precede
these difficulties by weeks to months and may provide an
important early clue to their onset. The mechanisms responsible
for drug-induced psychotic symptoms in PD are unknown, but
dopaminergic (especially mesolimbic) and serotoninergic systems
are likely to be involved. The treatment of the drug-induced
psychoses in PD should be undertaken in a stepwise manner. A
detailed discussion of this approach, including the use of anti-
PD medication adjustment, clozapine, and other medications
(neuroleptic and nonneuroleptic) and ECT is provided (see Fig.
1). Although drug-induced psychoses are the most important of
the drug-induced psychiatric states, mania, anxiety, and
hypersexuality may also occur. Depression is also common in PD,
but it is unlikely to occur as a side effect of antiparkinsonian
medications. [References: 150]


Unique Identifier
  94232390
Authors
  Hoflich G.  Burghof KW.  Kasper S.  Moller HJ.
Title
  [Electroconvulsive therapy in comorbidity of treatment
refractory paranoid hallucinatory psychoses with Parkinson
disease]. [German] Source Nervenarzt.  65(3):202-5, 1994 Mar.
Abstract We report the case of a 49-year-old woman with a
therapy resistant paranoid hallucinatory psychosis and
coexisting severe symptoms of Parkinson's disease. Over a 3-week
period she received electroconvulsive therapy (ECT) 10 times,
while the medication of haloperidol 8 mg/day, thioridazin 90
mg/day, metixen 17.5 mg/day and biperiden 6 mg/day was continued.
 There was a general improvement of the clinical picture, more
pronounced for the parkinson symptomatology than for the
psychotic disorder.


Unique Identifier
  94357731
Authors
  Zwil AS.  Pelchat RJ.
Title
  ECT in the treatment of patients with neurological and somatic
disease. [Review] Source International Journal of Psychiatry in
Medicine.  24(1):1-29, 1994. Abstract OBJECTIVE: An evaluation
of the safety and efficacy of electroconvulsive therapy (ECT),
for the treatment of patients with severe medical and
neurological illness, was undertaken. METHOD: The English-
language literature reporting the use of ECT in patients with
neurological and somatic disease was reviewed. This review
included reports describing ECT used for the treatment of
affective disturbances and catatonia in patients with concurrent
neurological or somatic disease, as well as reports dealing with
the efficacy of ECT for the treatment of certain neurological
conditions for which it has been reported to have some benefit
independent of its psychiatric effect. CONCLUSIONS: ECT is safe
and effective for the treatment of affective and catatonic
disorders in patients with most neurological and medical
diseases, including elderly and debilitated patients with
multiple illnesses, if the specific medical risks are carefully
evaluated in each case, and appropriate modifications of
technique are used to reduce the risk of potential complications.
 Apart from its use in psychiatry, ECT has been reported to have
therapeutic effects in Parkinson's disease, neuroleptic
malignant syndrome, aggressive behavioral disorders following
brain injury, certain forms of epilepsy, and some forms of
delirium due to toxic or metabolic encephalopathies. The
potential for ECT to play an active role in the clinical
management of patients with these disorders, many of whom are
presently refractory to maximal medical treatment, should be
evaluated by systematic studies. [References: 140]


Unique Identifier
  94139623
Authors
  Jeanneau A.
Title
  [Electroconvulsive therapy in the treatment of Parkinson
disease]. [Review] [French] Source Encephale.  19(5):573-8, 1993
Sep-Oct. Abstract This review of the literature shows that
Parkinson's disease can be considered as an indication of
sismotherapy. The therapeutic effects of ECT on the extra-
pyramidal syndrome are reviewed whether it is associated with a
depression or not. The various biological mechanisms of the
antiparkinsonian effect of ECT are discussed ie the increase of
the permeability of the brain blood barrier, the action on the
dopamin metabolism and the dopamin receptors and the action on
the opioid receptors and melatonin. The role of maintenance ECT
in the treatment of Parkinson's disease is cleared up. In
conclusion, it appears that sismotherapy can be considered as an
adjuvant therapy in Parkinson's disease especially when there is
a resistance to dopatherapy. [References: 45]


Unique Identifier
  93003842
Authors
  Kapur S.  Mann JJ.
Title
  Role of the dopaminergic system in depression. [Review]
Source
  Biological Psychiatry.  32(1):1-17, 1992 Jul 1.
Abstract
  A hypothesis implicating dopamine in depression was proposed
over 15 years ago (Randrup et al 1975). The identification of
multiple new subtypes of dopamine receptors and evolving views
regarding the function of the dopamine systems in the brain
require a reexamination of this hypothesis. Results from studies
in depression, Parkinson's disease, and animal models of
depression suggest a deficiency of dopamine in depression.
Dopamine precursors, dopamine agonists, and dopamine reuptake
inhibitors show therapeutic efficacy in depression.
Electroconvulsive therapy (ECT) and standard pharmacological
antidepressants enhance dopamine function. Studies using
receptor-specific drugs in clinical trials and neuroimaging
studies are needed to further clarify the role of dopamine in
depression. [References: 120]


Unique Identifier
  92142293
Authors
  Dam H.  Pakkenberg H.  Bolwig TG.
Title
  [Electric stimulation (ECT) in Parkinson disease]. [Danish]
Source
  Ugeskrift for Laeger.  154(4):183-7, 1992 Jan 20.
Abstract
  A case report and a review of the literature concerning
electroconvulsive therapy (ECT) in the treatment of Parkinson's
disease with special reference to the therapy of "on-off"
phenomena is given. The first report of positive effect appeared
in 1959 and, with a single exception, all published articles on
this topic point to a positive outcome of ECT. There seems to be
a specific anti-Parkinsonian effect alongside the well-known
effect on various psychotic conditions. ECT thus must be
considered a valuable intervention when drug therapy is
insufficient, when prolonged medication leads to decreased
efficacy, or when patients develop neuro-psychiatric
manifestations. A short review of the pathophysiological
mechanisms which may underly the effect of ECT in Parkinson's
disease is given.


Authors
  Cummings JL.
Title
  Depression and Parkinson's disease: a review [see comments].
[Review] Comments Comment in: Am J Psychiatry 1993
Feb;150(2):353-4, Comment in: Am J Psychiatry 1993
May;150(5):843-4 Source American Journal of Psychiatry.
149(4):443-54, 1992 Apr. Abstract OBJECTIVE: The purpose of this
review is to provide an update of the research regarding
depression in Parkinson's disease and to synthesize the
information into a neurobiological model relating the structural
and biochemical changes in this disorder to the behavioral
manifestations. METHOD: The author used a computer-based search
of the literature, augmented by extensive bibliography-guided
article reviews, to find information on depression and
Parkinson's disease. FINDINGS: Depression occurs in
approximately 40% of patients with Parkinson's disease;
depression in Parkinson's disease is distinguished from other
depressive disorders by greater anxiety and less self-punitive
ideation. Lower CSF levels of 5-hydroxyindoleacetic acid, a past
history of depression, and greater functional disability are
associated with a greater risk of depression in Parkinson's
disease. Female gender, early age at onset of Parkinson's
disease, and greater left brain involvement may also be risk
factors. Approximately half of depressed patients with
Parkinson's disease meet criteria for major depressive episodes;
half have dysthymia. Depression is more common in Parkinson's
disease with prominent bradykinesia and gait instability than in
tremor-dominant syndromes. Depressed patients with Parkinson's
disease have greater frontal lobe dysfunction and greater
involvement of dopaminergic and noradrenergic systems than
nondepressed patients with the disease. Mood changes in
Parkinson's disease respond to treatment with conventional
tricyclic antidepressants or ECT. CONCLUSIONS: Neurobiological
investigations suggest that depression in Parkinson's disease
may be mediated by dysfunction in mesocortical/prefrontal reward,
 motivational, and stress-response systems. Neuropsychological,
metabolic, clinical, pharmacological, and anatomical studies
support the involvement of frontal dopaminergic projections in
patients with Parkinson's disease and depression. [References:
99]

[log in to unmask]      That man may last, but never lives,
                        Who much receives, but nothing gives;
HomeBoy #Parkinsons         Whom none can love, whom none can thank,--
                               Creation's blot, creation's blank.
John Cottingham           Thomas Gibbons (1720-1785): When Jesus dwelt.