Hi all, I continue to look into ECT (electroconvulsive therapy). Just posted
the piece below to my blog, which I would appreciate folks visiting at
http://parkinsense.blogspot.com. If you go there it'll help the post get
noticed by search engines, which leads to reaching more readers. I think
that's how it goes. Anyway, there's a striking photo of lightning over the
bayou to make it worth your while!
I see the neglect of research on the effects of ECT on motor impairments of
PD as a major dropped ball...I am stunned that so little is known about an
intervention observed by many to show promise.
I will be posting more on ECT, its cousin TMS (transcranial magnetic
stimulation), and related therapies in the coming weeks.
Kathleen
==============================================================
Shocked
A couple of weeks ago, I read an article in the Huffington Post by Dr. Mark
Goulston.1 Dr. Goulston described his work in 1986 with a suicidal,
late-stage Parkinson’s patient who stepped back off the ledge after
receiving electroconvulsive therapy (ECT).
Because I have Parkinson’s disease, I read this post with particular
interest. Near the end of the article, my interest turned to shock. Dr.
Goulston noted, almost as an aside, that with ECT, not only did the
patient’s depression lift—his motor functioning improved as well.
I was diagnosed in 1997. Since then, I have become a Parkinson’s news and
information addict. Yet never before had I heard that ECT might be effective
in treating motor symptoms of Parkinson’s. How could I have missed this?
I dove into the Internet and discovered that over the last 50 years or so,
psychiatrists reported cases in which ECT helped Parkinson’s sufferers not
only with depression, but also with motor symptoms. Some of these
psychiatrists called for controlled studies to learn more about the effects
of ECT on PD, what risks ECT would pose, and what conditions and practices
would maximize ECT’s benefits and minimize risks.
Where, then, were the controlled studies?
Hunting for research on ECT, I discovered there is shockingly little to be
found. In 2003, authors of a review of articles on ECT and PD
(1990-2000)2concluded:
“ Overall, a substantial amount of data support the positive effects of ECT
on the motor symptoms of Parkinson’s disease. However, almost all of these
data are from case reports or cases series, with only one randomized
controlled trial in the literature. This, together with concerns over side
effects, may raise doubts among neurologists. Further research in
collaboration with neurological colleagues should be encouraged to address
these concerns, as *ECT may be a viable option that is acceptable to many
patients*.” [emphasis mine]
Authors of a meta-analysis of the literature (1980-2005)3 on ECT stated:
“…ECT can produce statistically significant effects on motor function in
PD….. For ECT, although there was a relatively large and significant effect
size, we considered the low number of studies to be a limiting factor, and
therefore avoid any definite conclusions about this method of brain
stimulation in PD.”
So 20-plus years after Dr. Goulston’s patient picked up his life again, PD
patients are not equipped to weigh the risks and benefits of ECT. In fact,
neurologists aren’t even talking about it. The research is insufficient. Why
is that? Because not enough studies have been done to make anyone want to do
further studies. The evidence on ECT is largely anecdotal and that simply
isn’t enough.
It’s a perfect circle, a Catch-22. And it leaves patients with only one
option when, inevitably, medications fail and symptoms worsen – DBS surgery,
which involves drilling holes in the skull, pushing wires through the brain,
and depending on batteries to keep a constant current pulsing through wires
inserted under the skin. If it comes to the point that I need that, I’ll do
it. But why has this procedure been deemed worthy of risk, worthy of study,
worthy of being paid for by Medicare, while ECT, simpler, noninvasive, and
far less expensive, has been shunted aside?
Two weeks’ worth of reading has not turned me into an expert on ECT. But
what I learned convinces me that there is a very good chance that ECT offers
another choice, an additional station along the way where patients can stave
off, for a little while longer, the ravages of this disease.
Only research will tell us if this choice pans out.
This research is long overdue.
References
*1. *Goulston, M. Living through wanting to die.* *The Huffington Post,
July 9, 2009.
http://www.huffingtonpost.com/mark-goulston-md/living-through-wanting-to_b_228811.html
**
2. Kennedy R, Mittal D, and O’Jile J. Electroconvulsive therapy in
movement disorders: an update. J Neuropsychiatry Clin Newurosci 2003;
15:407-421.
3. Fregni F, Simon DK, Wu A, and Pascal-Leone A. Non-invasive brain
stimulation for Parkinson’s disease: a systematic review and meta-analysis
of the literature. J Neural Neurosurg Psychiatry 2005; 76:1614-1623.
----------------------------------------------------------------------
To sign-off Parkinsn send a message to: mailto:[log in to unmask]
In the body of the message put: signoff parkinsn
