Innovations In Clinical Neuroscience

JAN-FEB 2018

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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C A S E S E R I E S 23 ICNS Innovations in Clinical Neuroscience • January–February 2018 • Volume 15 • Number 1–2 D Depression is a frequent comorbidity in patients with Parkinson's disease (PD). Evidence suggests that depression has a bidirectional relationship with PD, with either of the conditions increasing the risk of developing the other. 1,2 Incidence of depression in patients with PD has been reported to range from 1.86 to 5.1 percent per year, 3 with a prevalence rate of 2.7 to 55.6 percent. 1 This wide range of reported prevalence might be due to variations in assessment methods, clinical samples, and identification thresholds of mood disorders. Presence of comorbid depression often leads to further deterioration in quality of life and cognitive profile in these patients with PD. 4 Treatment options for comorbid depression and PD include antidepressants, cognitive behavioral therapy, and electroconvulsive therapy (ECT). 1,2,4 In addition to depression, ECT has also been shown to have a beneficial effect on the symptoms of PD, although the data are limited. 5,6 In 1947, Gallinek first reported the beneficial effect of ECT on symptoms of PD, 7 and, in 1975, Lebensohn et al 8 reported improvement in comorbid depression and PD symptoms following ECT. 8 In the current retrospective case series, we identified, via a search of our facility's ECT registry (2010–April 2017), six patients with comorbid depression and PD who underwent ECT. We describe their treatment and review the current literature on the use of ECT among patients with PD. CASE SERIES All six patients in our retrospective chart review received bitemporal modified brief pulse ECT. Prior to ECT, the patients underwent pre-ECT evaluation, which involved hemogram analysis, renal and liver function tests, fasting blood glucose analysis, chest X-ray (posteroanterior view), and serum electrolyte analysis, all of which were within the normal range for all six patients, and none of the patients showed evidence of raised intracranial pressure on fundoscopy examination. All patients provided written informed consent prior to starting ECT. Glycopyrrolate was used as a premedication, thiopentone was used for induction, and suxamethonium was used for muscle relaxation. Motor seizure of at least 15 seconds was considered effective. Details of different parameters are provided in Table 1. Case 1 . Mr. A, 56 years old, presented with a nine-year history of PD with recurrent depressive disorder (as per International Classification of Diseases, 10th Revision [ICD-10]). His medications included levodopa-carbidopa-entacapone, trihexyphenidyl, baclofen, rasageline, and mirtazapine. The patient reported that he had been experiencing a worsening of PD symptoms (e.g., increase in rigidity and tremors) and the need for assistance with activities of daily living (ADL)for the three months prior to presentation to our clinic, despite being on regular treatment. During the first month that he had begun to experience worsening PD symptoms, Mr. A A B S T R A C T Depression is a common comorbidity in patients suffering from Parkinson's disease (PD). Available evidence suggests that electroconvulsive therapy (ECT) is an effective treatment for depression and also improves symptoms of PD. However, literature on usefulness of ECT in parkinsonian symptoms is limited. A review of records of all patients receiving ECT from 2010 to April 2017 in the authors' clinic yielded six cases (0.63% of all patients who received ECT at the authors' center over last 7 years) of depression with PD who were treated with ECT. All six patients had improvement in both depression and symptoms of PD following ECT treatment. The improvement achieved with ECT was sustained in four patients. Worsening of PD symptoms 3 to 4 months post-treatment was seen in two patients. ECT appears to be an effective treatment option for management of motoric symptoms in patients with PD, especially those with comorbid psychiatric disorders. Keywords: Depression, Parkinson's disease, electroconvulsive therapy Effectiveness of Electroconvulsive Therapy (ECT) in Parkinsonian Symptoms: A Case Series by SANDEEP GROVER, MD; ADIT YA SOMANI, MD; NEERU SAHNI, MD; SAHIL MEHTA, DM; SWATI CHOUDHARY, MBBS; RAHUL KUMAR CHAKRAVART Y, MBBS; and ANJU MONI RABHA, MBBS Drs. Grover, Somani, Sahni, Mehta, Choudhary, Chakravarty, and Rabha are with the Post Graduate Institute of Medical Education and Research, Chadigarh in Chandigarh, India. Innov Clin Neurosci. 2017;15(1–2):23–27 FUNDING: No funding was provided for the preparation of this article. DISCLOSURES: The authors report no conflicts of interest relevant to this article. CORRESPONDENCE: Sandeep Grover, MD; Email: drsandeepg2002@yahoo.com

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