A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience
Issue link: https://innovationscns.epubxp.com/i/555782
Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 2 , N U M B E R 7 – 8 , J U L Y – A U G U S T 2 0 1 5 ] 28 ABSTRACT We performed a literature search regarding the safety and efficacy of electroconvulsive therapy in patients with multiple sclerosis and comorbid psychiatric symptoms. Literature review was conducted via PubMed databases. Of the cases we reviewed, most subjects with multiple sclerosis reported significant psychiatric symptom relief, with only a handful reporting neurologic deterioration. There was some evidence that active white matter lesions may be predictive of neurologic deterioration when electroconvulsive therapy is used in patients with multiple sclerosis. A brief description of the pathophysiology and effects of depression in patients with multiple sclerosis is also provided. Although no clinical recommendations or meaningful conclusions can be drawn without further investigation, the literature suggests that electroconvulsive therapy for treatment of psychiatric illnesses in patients with multiple sclerosis is safe and efficacious. INTRODUCTION Electroconvulsive therapy (ECT) is recognized as efficacious for treatment-refractory depression, mania, catatonia, and schizophrenia. 1 Additionally, it is sometimes indicated for patients with status epilepticus, neuroleptic malignant syndrome, dementia with agitation, and Parkinson's disease. 1 In the general population, the risks associated with ECT are low, similar to that associated with anesthesia. 2 However, there are no large trials reported or other literature analyzing the risk associated with ECT in patients with neurodegenerative disorders such multiple sclerosis (MS), Huntington's disease, amyotrophic lateral sclerosis, multiple system atrophy, or Alzheimer's disease. Given the neurologic deterioration seen in these disorders, there is legitimate concern that an ECT- induced seizure might have adverse effects on an already damaged nervous system. Additionally, people with these diseases having cognitive dysfunction are at increased risk for further deterioration by administering ECT. 2 The purpose of this article was to review and discuss the available literature for evidence regarding the efficacy and safety of ECT in the treatment of psychiatric illness in patients with MS. A brief description of the pathophysiology and effects of depression on patients with multiple sclerosis is also provided. METHOD A PubMed search was performed using the term electroconvulsive therapy and multiple sclerosis, by KATIE STEEN, MD; PUNEET NARANG, MD; and STEVEN LIPPMANN, MD Dr. Steen is psychiatry resident at the University of Minnesota, Minneapolis; Dr. Narang is Staff Physician and Lead ECT Psychiatrist, Regions Hospital, Minneapolis-St. Paul, Minnesota; and Dr. Lippmann is Professor of Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky. Innov Clin Neurosci. 2015;12(7–8):28–30 FUNDING: No funding was received for the preparation of this article. FINANCIAL DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article. ADDRESS CORRESPONDENCE TO: Steven Lippmann, MD, 550 S Jackson Street, ACB first floor, Louisville, KY 40202; Phone: (502) 852-1759; Fax: 502-852-5098; Email: sblipp01@louisville.edu KEY WORDS: ECT, electroconvulsive therapy, multiple sclerosis, depression [ R E V I E W ] Electroconvulsive Therapy in Multiple Sclerosis