Worsening of movement disorder following treatment with electroconvulsive therapy in a patient with Huntington’s disease

Abstract

This paper describes a patient who presented with treatment-resistant depression with comorbid anxiety symptoms in the context of Huntington’s disease (HD) and developed worsening movement disorder symptoms after commencing electroconvulsive therapy (ECT) for depression. The aim of this case report is to provide medical practitioners with a greater awareness of the possibility of worsening movement disorders when using ECT for depression in a patient with HD.

Electroconvulsive Therapy and Movement Disorders. New Perspectives on A Time‐Tested Therapy

“…The effect of ECT on catecholaminergic systems, including dopamine neurotransmission has been long suspected. 21,[50][51][52][53] In an experimental, in vivo, microdyalisis study, ECT produced large increases in interstitial concentrations of dopamine in the rat striatum. 51 In addition, after ECT, the levels of homovanillic acid in cerebrospinal fluid (CSF) of PD patients were significant increased, according to Fall et al 41 ECT may also act on postsynaptic level 21,41,52,53 modulating the dopamine receptors.…”

“…The effect of ECT on catecholaminergic systems, including dopamine neurotransmission has been long suspected 21,50–53 . In an experimental, in vivo, microdyalisis study, ECT produced large increases in interstitial concentrations of dopamine in the rat striatum 51 .…”

“…43 ECT has also been employed anecdotally for other movement disorders including multiple system atrophy 44 tardive dystonia 45 and neuroacanthocytosis. 46 Finally, several experimental 47 and clinical reports [48][49][50] on ECT in Huntington's disease (HD) with associated psychosis or severe depression have been published. However, Abeysundera et al described as a patient who presented with treatment-resistant depression with comorbid anxiety symptoms in the context of HD and developed worsening movement disorder after commencing electroconvulsive therapy.…”

“…However, Abeysundera et al described as a patient who presented with treatment-resistant depression with comorbid anxiety symptoms in the context of HD and developed worsening movement disorder after commencing electroconvulsive therapy. 50…”

Management of Agitation in Huntington’s Disease: A Review of the Literature

“…It is recommended to consider using ECT after a failed trial of antipsychotics with mood stabilizers, and the use of maintenance ECT for one month [26]. A recent case report in 2017 described an HD patient who developed worsening movement disorder symptoms after undergoing ECT for depression [27]. Clinicians should be mindful of the possibility of this side effect.…”