Electroconvulsive Therapy for Parkinson's Disease with Depression and Neuroleptic Malignant Syndrome: A Case Report

Abstract

Parkinson's disease is often complicated by psychiatric symptoms. Psychiatrists are caught in a dilemma between such symptoms and physical treatment since Parkinson's disease sometimes shows treatment resistance based on pharmacological treatment-induced dopamine dysfunction. Here, we report on a 64-year-old woman with a 15-year history of Parkinson's disease with stage IV severity based on the Hoehn and Yahr scale. She was admitted to our hospital with a diagnosis of major depressive disorder with psychotic features. Unfortunately, her treatment course for depression was complicated by neuroleptic malignant syndrome. Because we were concerned about the persistence of her depressive symptoms, the risk of psychotropic drugs causing adverse effects, and progressive disuse syndrome, we administered modified electroconvulsive therapy. Her symptoms of neuroleptic malignant syndrome and depression sufficiently improved after five sessions of modified electroconvulsive therapy. Additionally, the primary motor symptoms of her Parkinson's disease also markedly improved. The improvement of neuroleptic malignant syndrome and her motor symptoms based on dopamine dysfunction can be explained by electroconvulsive therapy's effectiveness in activating dopamine neurotransmission. Besides, the marked improvement of her depressive episode with psychotic features was presumed to involve dopamine receptor activation and regulation. Because advanced Parkinson's disease can sometimes be refractory to treatment based on pharmacological treatment-induced dopamine dysfunction, psychiatrists often have difficulty treating psychiatric symptoms; electroconvulsive therapy may stabilize the dopaminergic system in such cases, presenting a possible non-pharmacologic treatment option for Parkinson's disease.

Efficacy of Electroconvulsive Therapy for the Treatment of Movement Disorders: A Literature Review

“…The publications examined in this systematic review delineate ECT as an effective intervention for symptoms associated with various movement disorders. Several studies confirmed a positive relationship between this therapy and PD [31][32][33][34][35][36]. After the sixth and seventh weeks, ECT significantly improved psychiatric, motor, and major depressive symptoms among PD patients [31].…”

“…This effect depicts the therapy as a possible complementary intervention for treating and managing PD symptoms. Besides, ECT has been reported to reduce the symptoms of depression and malignant syndrome among PD patients [32]. Depression and malignant syndrome are critical symptoms of PD that cause adverse health implications.…”

“…Five other publications established a positive association between ECT and improved motor manifestations in patients with PD as well as their depression and psychosis symptoms [31], impulse control disorders [32], psychiatric symptoms [33], refractory psychiatric symptoms [34], and neuroleptic malignant syndrome [35]. A study involving 15 PD patients revealed that besides psychiatric symptoms, the therapy led to significant improvements in motor functionality after the end of the sixth and tenth weeks [31].…”

“…However, the researchers underscored the need for patients to undergo traditional treatment with ECT to record longlasting outcomes. One case study investigated the role of ECT in treating depression and neuroleptic malignant syndrome among PD patients [32]. The report focused on a 64-year-old woman with PD diagnosed with state 1V severity on the HY scale.…”

“…The patient was placed under ECT to appraise its efficacy in managing the two symptoms. The patient's depression and malignant syndrome, which is a life-threatening condition characterized by autonomic dysfunction, altered mental status, and muscle rigidity as a result of dopamine receptor blockade in the brain, improved significantly after receiving five sessions of modified ECT [32].…”