Classics in ECT: ECT for PD: Faber and Trimble Review From 1991

 "Classics in ECT" brings you this review from 1991:

Electroconvulsive therapy in Parkinson's disease and other movement disorders.

Faber R, Trimble MR.Mov Disord. 1991;6(4):293-303. doi: 10.1002/mds.870060405.PMID: 1758447 Review


The abstract is copied below:
Early case reports note marked improvements in the signs of Parkinson's disease (PD) in several patients with coexisting psychiatric disorders after treatment with electroconvulsive therapy (ECT). Studies since 1959 reveal improvement of parkinsonism in over half of PD patients receiving ECT, regardless of the presence or absence of psychiatric comorbidity. Drug-induced parkinsonism, tardive dystonia, and tardive dyskinesia have also been shown to improve with ECT administration; tic syndromes have achieved mixed results. In animals, ECT enhances dopamine-mediated effects and increases GABA concentrations in the CNS. Optimal parameters relevant to the antiparkinsonism effects of ECT require further study.

The article is here.

And from the text:




This is an excellent early review of the literature on ECT for PD and other movement disorders. The section on possible mechanisms of action is very well presented. It's pretty clear that ECT is a potent potentiator of the dopamine system.

A current PubMed search of "electroconvulsive Parkinson's" shows 327 citations. Despite this, it is remarkable how little acceptance there has been of ECT to treat PD. Perhaps if we are able to reduce the overall stigma associated with ECT, its utility in PD will be better recognized...
Dr. Faber has continued to champion this use of ECT over the intervening decades.

Comments

  1. RayFMay 21, 2022 at 12:17 PM

    Doctor Kellner has also championed ECT having a useful role to play in treating Parkinson’s disease.
    My experience has been that it is an extreme challenge for neurologists to consider a seizure, even in the optimized ECT setting, as therapeutic. Movement disorder specialists,though, generally acknowledge having seen PD symptoms improved, even markedly, with ECT yet they are reluctant to utilize ECT as a maintenance strategy in PD.
    Neuropsychiatrists and behavioral neurologists now work in tandem regarding cognitive disorders. Hopefully, the future will hold a similar alignment for movement disorders.

    ReplyDelete
  2. ECT BloggerMay 22, 2022 at 8:00 AM

    The below comment is from Dr. Max Fink:

    1980 I was approached by a wife accompanied by a rigid husband, seeking ECT to reduce rigidity to allow his card-playing. We offered a few seizures, the rigidity was reduced, and game playing returned. Over the next year, she called occasionally for a few seizures. When she went to Florida for the winter, I called on a colleague in U Miami for assistance.

    ECT was managed at Hillside Hospital in 1970s to1990s by Sam Bailine who maintained a PD clinic. Periodic calls for a few sessions repaired rigidity and sustained family happiness.

    Max Fink

    ReplyDelete

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