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It's interesting that ECT as a treatment for PD has been investigated and is being encouraged mostly by psychiatrists, who initially used it to treat depression, and then noticed improvement in PD symptoms. But there is little research reported by neurologists. It should be poinited out that it is not being proposed as a treatment for all PWP -- only for those in advanced stages who no longer get relief of their symptoms with the available PD meds. There are likely side-effects and the benefit/ risk ratio has to be considered. But ECT is less invasive than DBS surgery, and maybe safer? There are two good review articles listed below from 2003 and 2005. Been trying to find any updates. Both conclude that the small studies and case reports so far are not adequate, and further research is needed. Has it been done? So far can't find any evidence -- or have the results just not been published? Given the lack of options for advanced PD, it seems further investigation would be warranted. ---------- Original Message ---------- From: Kathleen Cochran <[log in to unmask]> To: [log in to unmask] Subject: More on PD and ECT Date: Mon, 13 Jul 2009 07:11:31 -0400 Thanks, Rick. Since reading Dr. Goulston's article, I've been doing some research on PD and ECT (electroconvulsive therapy, formerly known as shock therapy) and found several other articles, listed below. As far as I can tell, it's mainly a few people in the psychiatric community who have been talking about ECT and Parkinson's. Have the movement disorders people (and the drug companies) noticed? I find it astounding that hardly anyone has bothered to look at possible benefits for Parkinson's patients from ECT, a noninvasive, widely used procedure that has been greatly refined since its inception in the 1930s and is tolerated well by many recipients. Here are some links: 1989 http://ajp.psychiatryonline.org/cgi/content/abstract/146/11/1451 http://www.faqs.org/abstracts/Psychology-and-mental-health/ECT-for-Parkinsons-disease-Differential-effects-of-right-unilateral-and-bilateral-ECT-on-heart-rate.html 1991--part of a letter http://journals.lww.com/ectjournal/Citation/1991/09000/ECT_for_Refractory_Parkinson_s_Disease.10.aspx 1995 http://www.ncbi.nlm.nih.gov/pubmed/9620060 2003 http://jap.sagepub.com/cgi/content/abstract/9/1/9 a letter and a response to the letter: http://www.cmaj.ca/cgi/content/full/168/11/1391-b http://www.cmaj.ca/cgi/content/full/168/11/1392<http://www.cmaj.ca/cgi/content/full/168/11/1392http://www.cmaj.ca/cgi/content/full/168/11/1392> 2005 There is a link to a downloadable PDF of this article. http://www.pubmedcentral.nih.go/articlerender.fcgi?artid=1739437 Here's a quote from pp. 5-6 of the PDF: "Although we show that the effects of ECT are significant and, indeed, had a larger effect size when compared to TMS [transcranial magnetic stimulation], the small number of trials limits our ability to draw any definite conclusion about this technique in PD patients." 2009 This thanks to Linda Herman: "The scientific and clinical basis for the treatment of Parkinson disease (2009)" by C. Warren Olanow, Matthew B. Stern, MD, Kapil Sethi, MD. Neurology, 2009;72 (Suppl 4);S1-S136. As part of the discussion they say:** *"Electroconvulsive therapy has been used to* *manage severe depression in PD that cannot be controlled* *with more traditional approaches. Benefits in* *both depression and parkinsonian motor features have* *been observed,**733,734 **although the latter are typically* *transient and disappear in weeks to months, and this* *procedure is not widely used."* The two cited articles were written in 1989 and 1991. 2009/7/12 Rick Everett <[log in to unmask]> > Full text is available- > > > 1: J Neuropsychiatry Clin Neurosci. 2003 Fall;15(4):407-21. > > Electroconvulsive therapy in movement disorders: an update. > > Kennedy R, Mittal D, O'Jile J. > > Department of Psychiatry, University of Missippi Medical Center, Jackson, > USA. > [log in to unmask] > > Electroconvulsive therapy (ECT) is a well-recognized treatment for > psychiatric > illness, primarily depressive disorders. Its use in patients with > neurological > illnesses is steadily increasing. Older reviews indicate that ECT may also > benefit Parkinson's disease and similar movement disorders independent of > its > effects on comorbid psychiatric disorders. In this updated review, recent > literature regarding ECT and movement disorders is summarized from 1990 to > 2000. > Considerable evidence indicates that ECT improves motor symptoms of > Parkinson's > disease in patients with and without mood disorders. A few case reports, > ranging > from one to six patients per disorder, suggest that ECT may ameliorate the > motor > symptoms of other movement disorders. ECT affects a variety of > neurotransmitters > that play a role in these diseases. Limitations of current reports are > reviewed, > and recommendations for further investigation are made. > > > PMID: 14627767 [PubMed - indexed for MEDLINE] > > ---------------------------------------------------------------------- > To sign-off Parkinsn send a message to: mailto: > [log in to unmask] > In the body of the message put: signoff parkinsn > ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn