Electroconvulsive therapy for depression in a Parkinson's disease patient with bilateral subthalamic nucleus deep brain stimulators

Chou, Kelvin L.; Hurtig, Howard I.; Jaggi, Jurg L.; Baltuch, Gordon H.; Pelchat, Rodney; Weintraub, Daniel

doi:10.1016/j.parkreldis.2005.04.005

Cited by 54 publications

(35 citation statements)

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“…DBS has been shown to trigger depressive symptoms and it may worsen a preexisting depressive disorder [7, 16]. Our patient’s profound mood disorder, however, was not seen with the original placement of DBS electrodes nor the delivery of current.…”

Section: Discussionmentioning

confidence: 76%

“…The manifestations were resolved within 90 s after stopping the stimulation. However, Chou et al [7] found that turning off DBS in a patient suffering from psychotic depressive episodes following DBS did not lead to improvements in symptoms. There are other cases in which patients relapsed into depression after DBS placement while having prior history of major depression.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, genetic predisposition to Parkinson’s disease (PD) may increase the susceptibility to parkinsonism after head trauma [6]. Although treatment options are essentially the same as for those suffering from idiopathic PD, patients with post-traumatic Parkinson’s syndrome are often refractory to conventional pharmacologic treatment [2, 7]. Alternative treatment options do exist, such as deep brain stimulation (DBS), which has been established as an effective treatment option for PD as well as other movement disorders.…”

Section: Introductionmentioning

confidence: 99%

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Administration of electroconvulsive therapy for depression associated with deep brain stimulation in a patient with post-traumatic Parkinson’s Disease: a case study

et al. 2016

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BackgroundDeep brain stimulation (DBS) has been shown to be effective for parkinsonian symptoms poorly responsive to medications. DBS is typically well-tolerated, as are the maintenance battery changes. Here we describe an adverse event during a battery replacement procedure that caused rapid onset of severe depression.Case PresentationThe patient is a 58-year-old woman who was in a serious motor vehicle accident and sustained a concussion with loss of consciousness. Within weeks of the accident she began developing parkinsonian symptoms that progressively worsened over the subsequent 10 years. Responding poorly to medications, she received DBS, which controlled her movement symptoms. Five years after initiating DBS, during a routine battery change, an apparent electrical event occurred that triggered the rapid onset of severe depression. Anti-seizure and antidepressant medications were ineffective, and the patient was offered a course of electroconvulsive therapy (ECT), which resulted in complete reversal of her depressive episode.ConclusionParkinson’s syndrome can be seen after a single closed head injury event. Post-traumatic parkinsonism is responsive to DBS; however, DBS has been associated with an infrequent occurrence of dramatic disruption in mood. ECT is a therapeutic option for patients who develop intractable depressive illness associated with DBS.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Administration of electroconvulsive therapy for depression associated with deep brain stimulation in a patient with post-traumatic Parkinson’s Disease: a case study

et al. 2016

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“…Furthermore, the stimulation of DA release, in addition to stimulation of other monoaminergic effects, may also play a role in the antidepressant and antipsychotic effects of ECT. In recent years, several case reports [12,[69][70][71] have demonstrated the efficacy and safety of ECT in PD patients with severe, unremitted depressive and/or psychotic features, even implanted with deep-brain stimulation devices [for a review see ref . 41 ].…”

Section: Discussionmentioning

confidence: 99%

Antiparkinsonian Mechanism of Electroconvulsive Therapy in MPTP-Lesioned Non-Human Primates

et al. 2012

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Background: Electroconvulsive therapy (ECT), an effective treatment for depression, also improves motor symptomatology in Parkinson’s disease (PD). We have previously demonstrated that ECT stimulates dopamine (DA) function in the striatum of healthy non-human primates, suggesting that DA may contribute to antidepressant effects. Objective: We investigated the potential role of DA mechanisms in the amelioration of PD symptoms following a clinical course of ECT. Methods: We treated non-human primates rendered mildly bilaterally or unilaterally parkinsonian with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), with a course of 6 ECT treatments. Using positron emission tomography, animals were scanned at baseline and at various time points after ECT with tracers of the DA system. Data were analyzed using the Logan reference tissue model and statistics were performed using orthogonal polynomial contrasts. Results: There was no change in binding of the DA transporter tracer in the lesioned striata after ECT as opposed to what we measured in the striatum of healthy animals. Raclopride binding to the D_2/3 receptors was unaffected in all groups. However, there were increases in vesicular monoamine transporter type 2 and D₁ receptor binding in the MPTP-lesioned striata after ECT, returning towards baseline by 6 weeks. Conclusion: We suggest that the effects of ECT in PD may proceed from a mechanism similar to that in healthy animals but with a blunted dopaminergic response, likely due to the significant loss of striatal DA terminals. The safety of ECT, its mild side effects and its stimulatory effects of the DA system may thus make it an attractive adjunct to antiparkinsonian treatment.

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“…83,84 Interestingly, ECT has been observed to also improve motor symptoms in these patients. However, the existing literature on ECT in PD patients consists only of case studies; 59 therefore, more research in the form of RCTs is needed before ECT would be a recommended therapy for psychiatric symptoms in PD.…”

Section: Alternative Treatmentsmentioning

confidence: 96%

Prevalence, impact, and management of depression and anxiety in patients with Parkinson’s disease

Renfroe

Turner²,

Hinson³

2016

JPRLS

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Electroconvulsive therapy for depression in a Parkinson's disease patient with bilateral subthalamic nucleus deep brain stimulators

Cited by 54 publications

References 13 publications

Administration of electroconvulsive therapy for depression associated with deep brain stimulation in a patient with post-traumatic Parkinson’s Disease: a case study

Administration of electroconvulsive therapy for depression associated with deep brain stimulation in a patient with post-traumatic Parkinson’s Disease: a case study

Antiparkinsonian Mechanism of Electroconvulsive Therapy in MPTP-Lesioned Non-Human Primates

Prevalence, impact, and management of depression and anxiety in patients with Parkinson’s disease

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Electroconvulsive therapy for depression in a Parkinson's disease patient with bilateral subthalamic nucleus deep brain stimulators

Cited by 54 publications

References 13 publications

Administration of electroconvulsive therapy for depression associated with deep brain stimulation in a patient with post-traumatic Parkinson’s Disease: a case study

Administration of electroconvulsive therapy for depression associated with deep brain stimulation in a patient with post-traumatic Parkinson’s Disease: a case study

Antiparkinsonian Mechanism of Electroconvulsive Therapy in MPTP-Lesioned Non-Human Primates

Prevalence, impact, and management of depression and anxiety in patients with Parkinson&rsquo;s disease

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Prevalence, impact, and management of depression and anxiety in patients with Parkinson’s disease