 |
 |
Thnaks Ray and Diane, I read the full article text - it turned out to be an editorial . Here are some excerpts: ECT for Parkinson's disease. Popeo D, Kellner CHMed Hypotheses. 2009 Aug 4; Abstract: Parkinson's disease (PD) is a chronic, progressive, degenerative disorder that affects over five million people worldwide. Pharmacotherapy with dopamine enhancing medications is the mainstay of treatment. Neurosurgical techniques, ranging from pallidotomy to deep brain stimulation (DBS) are used in refractory patients. Another treatment, electroconvulsive therapy (ECT), has repeatedly been shown to have beneficial effects in PD, but has never gained acceptance as a clinical treatment option. We review the literature on the use of ECT in PD, pointing out that ECT has beneficial effects on both the core motor symptoms of PD as well as the commonly occurring psychiatric co-morbidities. ECT is hypothesized to act in PD by enhancing dopamine neurotransmission, including increasing sensitivity of dopamine receptors. The beneficial effects of ECT in PD persist for variable periods. Maintenance ECT has been used to increase the length of benefit. The stigma surrounding ECT has likely been responsible for its lack of use in PD. We suggest that ECT has a role in the treatment of PD, both in patients with PD alone, or PD with co-occurring depression Here are some excerpts: A number of small studies were performed in the 1970's-90's showing improvement of motor symptons, and re described."Since Wengel’s report was published in 1998, several other cases and reviews have appeared, showing the favorable effect of ECT in the treatment of PD and Parkinsonism, both in individuals with and without concomitant psychiatric illness. In recent reviews of the treatment of PD, however, ECT is rarely mentioned. In a recent search of the practice guidelines in the American Academy of Neurology website, the only guideline that resulted from a search of ECT that related to PD was a slide presentation on ‘‘Evaluation and Treatment of Depression, Psychosis, and Dementia in Parkinson Disease.” It does not recommend ECT as a non-pharmacological treatment, due to lack of good evidence [14]. A current review of the treatment of PD by a neurologist at our own institution (Mt. Sinai) does not mention ECT as a possible treatment at all [15]. It is unfortunate that ECT has never gained favor with neurologists in the treatment of PD In fact, the treatment is not even mentioned in any current treatment guidelines or exhaustive reviews on the subject. Perhaps this is because there is so much excitement in the possibilities of Deep Brian Stimulation (DBS) for those with medication resistant or intractable disease. ..." " Unfortunately, it is a likely reality that the stigma surrounding ECT is the main reason for its lack of use in PD. Such stigma persists, despite some encouraging signs that it is decreasing and that ECT is being considered a more ‘‘mainstream’ treatment in Psychiatry [17]. One of the reasons for ongoing stigma is our lack of knowledge of the antidepressant mechanism of action of ECT. (Who is resisting this treatment dur to the "stigma" ? The patients or the neuros? --LH) Interestingly, we believe we understand that it is the dopamine enhancing effect of ECT that leads to its effectiveness in PD [18]. On balance, we feel that ECT has a role in the treatment of PD, particularly in those patients with coexisting severe depression and PD. While we recognize that it will never be a widely used treatment for PD, it may have a larger role than currently practiced.." But with all the anecdotal evidence, and a lack of options for advanced PD patients, it just makes sense to do more research on ECT as a potential treatment for at least some PWP. I can't understand why there has been so little interest among neurologists . Or has it been difficult to find sponsors ? Doesn't seem like there would be much money to be made in developing ECT treatments for PD. ---------- Forwarded Message ---------- From: rayilynlee <[log in to unmask]> To: [log in to unmask] Subject: ECT for PD Date: Mon, 10 Aug 2009 00:23:28 -0700 Rayilyn Brown Director AZNPF Arizona Chapter National Parkinson Foundation [log in to unmask] From: Diane Wyshak Sent: Sunday, August 09, 2009 12:34 PM To: ray ; chew Nee Kong Subject: HubMed Abstracts http://www.hubmed.org/display.cgi?uids=19660875 ---------------------------------------------------------------------- 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