Safe ECT in MS: New Case Report From Germany

Out on Pubmed, from clinicians in Germany, is this case report:

Immunological changes following electroconvulsive therapy in multiple sclerosis.

Kavakbasi E, Rodner F, Nimalavachchlan L, Schwarte K, Schettler C, Bonnekoh LM, Opel N, Peine AC, Baune BT, Hohoff C.J Psychiatr Res. 2022 Apr 3;150:180-183. doi: 10.1016/j.jpsychires.2022.03.061. Online ahead of print.  PMID: 35390698

The abstract is copied below:Introduction: Electroconvulsive therapy (ECT) is a well-established treatment option in case of treatment-resistant depression (TRD). Only a few cases of ECT in depressed patients with multiple sclerosis (MS) were reported so far suggesting efficacy for the treatment of severe depression in MS, while data on possible neurological deterioration remained unclear.

Methods: In this case study we report on a case of a middle-aged man with MS. He was on dimethyl fumarate for relapse prevention since 2019 and without signs of active disease in a recent cerebral MRI. He suffered from treatment-resistant severe bipolar depression and thus received a total of 14 ECT sessions. We changed from right-unilateral to bilateral stimulation technique after the 7th session. We rated depression severity and measured biomarkers of neurodegeneration and inflammation before and after the ECT series to determine the impact of ECT on tolerance, response and neurobiology.

Results: The ECT series was tolerated well without neurological deterioration and any new neurological symptoms. The seizure quality was sufficient on average. We saw partial response corresponding to an improvement of about 35% in BDI-II and MADRS. The concentration of inflammation and neurodegeneration biomarkers was low both pre-treatment and post-treatment with increases from pre- to post ECT mainly in the CCL-2 pathway.

Conclusion: In our patient with TRD and MS ECT was safe and feasible. We did not see any neurobiological signs of disease activation of MS or neurodegeneration during the course of ECT, which may even be beneficial as it led to increase in the neuroprotective CCL-2 pathway in the presented patient.

Keywords: Bipolar depression; ECT; Electroconvulsive therapy; Immunology; Inflammation; MS; Multiple sclerosis; Treatment resistant depression.

The case report is here.

And from the text:

This is a useful case report that adds to the small evidence base of the safety and efficacy of ECT in MS. The detailed pre-post ECT measurement of immunological markers is interesting, both from the MS point of view and the inflammation hypothesis of depression.For followers of the immunology/inflammation in ECT literature, I recommend a full read, ~10 minutes.