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.