Even More on ECT for Parkinson's Disease
Out on PubMed, from investigators in Japan, is this paper:
Effectiveness of Electroconvulsive Therapy in Patients With Advanced Parkinson Disease.
J ECT. 2020 Dec 17;Publish Ahead of Print. doi: 10.1097/YCT.0000000000000732. Online ahead of print.PMID: 33337651
The abstract is copied below:
Objectives: In addition to motor symptoms, patients with Parkinson disease (PD) experience various psychiatric comorbidities, including impulse control disorders (ICDs). Moreover, antiparkinsonian drugs sometimes cause psychiatric symptoms. Antiparkinsonian and antipsychotic drugs are competitive in pharmacodynamics, and psychotropic drugs, including antidepressants, may worsen motor symptoms or induce adverse reactions. Considering this conflicting situation, we examined the effectiveness of electroconvulsive therapy (ECT) on both motor and psychiatric symptoms in PD.
Methods: We retrospectively examined 12 PD patients with advanced motor symptoms and drug-resistant psychiatric symptoms, including ICDs, who had undergone ECT. Both before and after ECT, the severity of PD motor symptoms were evaluated using Hoehn and Yahr staging, while psychiatric symptoms were evaluated using the Neuropsychiatric Inventory. The patients' doses of antiparkinsonian and antipsychotic drugs were also assessed before and after ECT.
Results: Both the mean Hoehn and Yahr and Neuropsychiatric Inventory scores were significantly decreased after ECT. The symptoms of ICDs, which were observed in 5 patients, disappeared following ECT. Improvements in motor symptoms and psychiatric symptoms lasted for more than 1 year in 5 cases and 9 cases, respectively. Furthermore, the daily dose of antiparkinsonian drugs was significantly decreased in 6 cases.
Conclusions: Our results demonstrated that ECT was effective for both severe motor symptoms and psychiatric symptoms in advanced PD patients. ECT might be a solution for the conflicting problem of treating both motor and psychiatric symptoms in PD.
And from the text:
For the nonpharmacotherapeutic treatment of psychiatric symptoms, a range of options, including electroconvulsive therapy (ECT)6 and repetitive transcranial magnetic stimulation,3 have been examined. Electroconvulsive therapy artificially induces seizures using electric stimulation and has been widely used for psychiatric disorders, such as depression and schizophrenia. Additionally, several case series have also been reported in PD.7–11 However, the sample sizes of these reports are relatively small, and some did not conduct quantitative evaluations. Moreover, no solid randomized controlled trials on the evaluation of psychiatric symptoms have been published.6 Therefore, evidence on the effectiveness of ECT in advanced PD cases with psychiatric symptoms has not yet been established, the long-term effect and safety of ECT has not been confirmed, and the American Academy of Neurology does not mention ECT as a treatment option for PD.This retrospective case series add to the evidence base for the beneficial effects of ECT for both motor and psychiatric symptoms in PD. Strengths of the report include the quantification of both motor and behavioral symptoms, as well as medication doses. The number of ECT in the acute course is not mentioned; presumably no maintenance ECT was given, but this is not specified. Despite this, some of the patients had durable benefit, either for motor or psychiatric symptoms, or both.
Remarkably, four patients who were either wheelchair-bound or bedridden, were reported to be able to walk after ECT.
An additional benefit of reading this paper was the introduction to the word, "punding." According to Wikipedia:
Punding is a term that was coined originally to describe complex prolonged, purposeless, and stereotyped behaviour in phenmetrazine and chronic amphetamine users, by Swedish forensic psychiatrist G. Rylander, in 1968. It was later described in Parkinson's disease.
I thank our Japanese colleagues (and Dr. Vaughn McCall, Editor of JECT) for this excellent contribution to the ECT PD literature.
The neurology community continuing to turn a blind eye to ECT as a possible therapeutic for PD is a real shame.
The below comment is from Dr. Ray Faber:
ReplyDeleteI wholeheartedly endorse Dr. Kellner's comments. This is another substantive addition to the literature reporting on the benefits of ECT on both the motor and non-motor manifestations of Parkinson's disease. Neurologists widespread lack of enthusiasm or even consideration of ECT in their PD patients is a continuing frustration for ECT practitioners who have witnessed the benefits of ECT in patients with PD. Publications such as this by Murayama et al are welcome additions to the literature which will hopefully eventuate in studies with level 1 evidence.
Ray Faber