Hi all,

I continue to look into ECT (electroconvulsive therapy). Just posted the piece below to my blog, which I would appreciate folks visiting at http://parkinsense.blogspot.com. If you go there it'll help the post get noticed by search engines, which leads to reaching more readers. I think that's how it goes. Anyway, there's a striking photo of lightning over the bayou to make it worth your while!

I see the neglect of research on the effects of ECT on motor impairments of PD as a major dropped ball...I am stunned that so little is known about an intervention observed by many to show promise.

I will be posting more on ECT, its cousin TMS (transcranial magnetic stimulation), and related therapies.

Kathleen

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Shocked

A couple of weeks ago, I read an article in the Huffington Post by Dr. Mark Goulston.1 Dr. Goulston described his work in 1986 with a suicidal, late-stage Parkinson’s patient who stepped back off the ledge after receiving electroconvulsive therapy (ECT).

Because I have Parkinson’s disease, I read this post with particular interest. Near the end of the article, my interest turned to shock. Dr. Goulston noted, almost as an aside, that with ECT, not only did the patient’s depression lift—his motor functioning improved as well.

I was diagnosed in 1997. Since then, I have become a Parkinson’s news and information addict. Yet never before had I heard that ECT might be effective in treating motor symptoms of Parkinson’s. How could I have missed this?

I dove into the Internet and discovered that over the last 50 years or so, psychiatrists reported cases in which ECT helped Parkinson’s sufferers not only with depression, but also with motor symptoms. Some of these psychiatrists called for controlled studies to learn more about the effects of ECT on PD, what risks ECT would pose, and what conditions and practices would maximize ECT’s benefits and minimize risks.

Where, then, were the controlled studies?

Hunting for research on ECT, I discovered there is shockingly little to be found. In 2003, authors of a review of articles on ECT and PD (1990-2000)2 concluded:

“ Overall, a substantial amount of data support the positive effects of ECT on the motor symptoms of Parkinson’s disease. However, almost all of these data are from case reports or cases series, with only one randomized controlled trial in the literature. This, together with concerns over side effects, may raise doubts among neurologists. Further research in collaboration with neurological colleagues should be encouraged to address these concerns, as ECT may be a viable option that is acceptable to many patients.” [emphasis mine]

Authors of a meta-analysis of the literature (1980-2005)3 on ECT stated:

“…ECT can produce statistically significant effects on motor function in PD….. For ECT, although there was a relatively large and significant effect size, we considered the low number of studies to be a limiting factor, and therefore avoid any definite conclusions about this method of brain stimulation in PD.”

So 20-plus years after Dr. Goulston’s patient picked up his life again, PD patients are not equipped to weigh the risks and benefits of ECT. In fact, neurologists aren’t even talking about it. The research is insufficient. Why is that? Because not enough studies have been done to make anyone want to do further studies. The evidence on ECT is largely anecdotal and that simply isn’t enough.

It’s a perfect circle, a Catch-22. And it leaves patients with only one option when, inevitably, medications fail and symptoms worsen – DBS surgery, which involves drilling holes in the skull, pushing wires through the brain, and depending on batteries to keep a constant current pulsing through wires inserted under the skin. If it comes to the point that I need that, I’ll do it. But why has this procedure been deemed worthy of risk, worthy of study, worthy of being paid for by Medicare, while ECT, simpler, noninvasive, and far less expensive, has been shunted aside?

Two weeks’ worth of reading has not turned me into an expert on ECT. But what I learned convinces me that there is a very good chance that ECT offers another choice, an additional station along the way where patients can stave off, for a little while longer, the ravages of this disease.

Only research will tell us if this choice pans out.

This research is long overdue.



References

1. Goulston, M. Living through wanting to die. The Huffington Post, July 9, 2009. http://www.huffingtonpost.com/mark-g..._b_228811.html

2. Kennedy R, Mittal D, and O’Jile J. Electroconvulsive therapy in movement disorders: an update. J Neuropsychiatry Clin Newurosci 2003; 15:407-421.

3. Fregni F, Simon DK, Wu A, and Pascal-Leone A. Non-invasive brain stimulation for Parkinson’s disease: a systematic review and meta-analysis of the literature. J Neural Neurosurg Psychiatry 2005; 76:1614-1623.