Correspondence

Treatment of Parkinson's Disease

N Engl J Med 1994; 330:643-644March 3, 1994

Article

To the Editor:

In his review, Calne (Sept. 30 issue)1 mentioned the use of electroconvulsive therapy in the treatment of drug-induced psychosis in patients with Parkinson's disease, but he did not discuss its use in treating the manifestations of the disease itself.

Depression is frequently associated with Parkinson's disease. In some patients the severity of the depression, the failure of antidepressant medications, or the complex pharmacotherapy of Parkinson's disease makes electroconvulsive therapy the most appropriate method of treatment. In addition to relieving the symptoms of depression, it may relieve the parkinsonian symptoms of bradykinesia, tremor, rigidity, gait disturbance, and postural instability,2,3 often with fewer treatments than are required to relieve the depressive symptoms. Electroconvulsive therapy is therefore an effective treatment for Parkinson's disease, even in the absence of depression4,5. The improvement can be dramatic, but may be short-lived. In patients who no longer respond to drug therapy alone, a trial of electroconvulsive therapy should be considered.

Thomas A. Grieger, M.D.
Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799

Kelly Cozza, M.D.
Scott Armstrong, M.D.
Walter Reed Army Medical Center, Washington, DC 20307-5001

5 References

1. 1

   Calne DB. Treatment of Parkinson's disease. N Engl J Med 1993;329:1021-1027
   Full Text | Web of Science | Medline

2. 2

   Douyon R, Serby M, Klutchko B, Rotrosen J. ECT and Parkinson's disease revisited: a “naturalistic” study. Am J Psychiatry 1989;146:1451-1455
   Web of Science | Medline

3. 3

   Burke WJ, Peterson J, Rubin EH. Electroconvulsive therapy in the treatment of combined depression and Parkinson's disease. Psychosomatics 1988;29:341-346
   Web of Science | Medline

4. 4

   Andersen K, Balldin J, Gottfries CG, et al. A double-blind evaluation of electroconvulsive therapy in Parkinson's disease with “on-off” phenomena. Acta Neurol Scand 1987;76:191-199
   CrossRef | Web of Science | Medline

5. 5

   Rasmussen K, Abrams R. Treatment of Parkinson's disease with electroconvulsive therapy. Psychiatr Clin North Am 1991;14:925-933
   Web of Science | Medline

Author/Editor Response

Dr. Calne replies:

To the Editor: I agree that electroconvulsive therapy can sometimes be helpful in the management of Parkinson's disease; however, both the efficacy and the undesirable actions of electroconvulsive therapy are difficult to evaluate because of the limitations associated with conducting a controlled study of this form of therapy. Nevertheless, accumulating clinical experience suggests that in suitable patients electroconvulsive therapy may ameliorate the depression that is often associated with Parkinson's disease, reduce the hallucinations and delusions that occasionally complicate treatment with dopaminomimetic agents, and improve the motor deficits of Parkinson's disease. Together with colleagues who have a shared interest in these problems, I have drawn attention to the potential value of electroconvulsive therapy,1 but have also pointed out that there may be adverse consequences that outweigh the benefits, particularly in patients who have confusion or dementia associated with Parkinson's disease.

My paper was written for the Journal's “Drug Therapy” series, so I focused my attention on the use of medications. A comprehensive discussion that included all forms of management, such as electroconvulsive therapy, physical therapy, speech therapy, and occupational therapy, was not possible. All these therapies may be beneficial in patients with Parkinson's disease and should be considered.

D.B. Calne, D.M.
University of British Columbia, Vancouver, BC V6T 2B5, Canada

1 References

1. 1

   Hurwitz TA, Calne DB, Waterman K. Treatment of dopaminomimetic psychosis in Parkinson's disease with electroconvulsive therapy. Can J Neurol Sci 1988;15:32-34
   Web of Science | Medline

Citing Articles (2)

Citing Articles

1. 1

   K.Ranga R Krishnan, Mahlon Delong, Helena Kraemer, Robert Carney, David Spiegel, Christopher Gordon, William McDonald, Mary Amanda Dew, George Alexopoulos, Kathleen Buckwalter, Perry D Cohen, Dwight Evans, Peter G Kaufmann, Jason Olin, Emeline Otey, Cynthia Wainscott. (2002) Comorbidity of depression with other medical diseases in the elderly. Biological Psychiatry 52:6, 559-588
   CrossRef

2. 2

   T. Yeghen, S. Benjamin, O. Boyd, C. Pumphrey, D. H. Bevan. (1995) Sickle cell anemia, right atrial thrombosis, and the antiphospholipid antibody. American Journal of Hematology 50:1, 46-48
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