ECT for Parkinson's disease.

Parkinson's disease (PD) is a chronic, progressive, degenerative disorder that affects over five million people worldwide. Pharmacotherapy with dopamine enhancing medications is the mainstay of treatment. Neurosurgical techniques, ranging from pallidotomy to deep brain stimulation (DBS) are used in refractory patients. Another treatment, electroconvulsive therapy (ECT), has repeatedly been shown to have beneficial effects in PD, but has never gained acceptance as a clinical treatment option. We review the literature on the use of ECT in PD, pointing out that ECT has beneficial effects on both the core motor symptoms of PD as well as the commonly occurring psychiatric co-morbidities. ECT is hypothesized to act in PD by enhancing dopamine neurotransmission, including increasing sensitivity of dopamine receptors. The beneficial effects of ECT in PD persist for variable periods. Maintenance ECT has been used to increase the length of benefit. The stigma surrounding ECT has likely been responsible for its lack of use in PD. We suggest that ECT has a role in the treatment of PD, both in patients with PD alone, or PD with co-occurring depression.