ECT outside of Mental Illness: Epilepsy, Neuroleptic Malignant Syndrome, Parkinson's Disease
Poorly controlled epilepsy
There are three areas where reference to ECT is made that are outside of the remit of mental health services. The first is the suggestion that patients with intractable epilepsy - who suffer from regular but disabling seizures - might be able to use ECT to 'pick' the most convenient time to have their seizures and hence improve their quality of life (ECT having anti-epileptic properties).
I know of nowhere, where this is actually done - the idea may therefore be a theoretical one.
Neuroleptic Malignant Syndrome
This is a life threatening condition felt to be triggered in part by the administration of neuroleptic (antipsychotic) drugs.
CLICK here for links to the NEUROLEPTIC MALIGNANT SYNDROME INFORMATION SERVICE a not-for-profit organisation founded in 1997 in the USA and NMS information at the NATIONAL INSTITUTE FOR NEUROLOGICAL DISORDERS AND STROKE
NMS is characterised by fluctuations in the patients concious level, blood pressure and pulse, together with a markedly raised temperature and muscle rigidity. Muscle damage may occur and the resulting muscle cell death can prove toxic to the kidneys.
A range of supportive measures including removal of exposure to neuroleptic, intensive care nursing, benzodiazepines, muscle relaxants and dopamine agonist drugs are variably recommended, but the reader is directed to the above links for fuller information.
ECT has been used additionally to treat NMS with a resulting reduced mortality (Caroff SN, Mann SC, Keck PE Jr, Francis A. Residual catatonic state following neuroleptic malignant syndrome. Journal of Clinical Psychopharmacology 2000; 20: 257-259.). Indeed I understand patients may be transferred from intensive care to receive such treatments in an emergency.
Electroconvulsive Therapy In Parkinsons' Disease
I shall not go into the complexities of PD here, but would point out occasional reports suggesting that patients with poorly L-dopa responsive PD can show a limited improvement in response to this treatment after a course of ECT. The duration of this improvement is limited however.
References relating to ECT and Parkinson's Disease and other degenerative disorders
- Wengel SP, Burke WJ,Pfeiffer RF,Roccaforte WH,Paige SR,(1998) Maintenance Electroconvulsive Therapy for Intractable Parkinson's Disease. Am J Geriatr Psychiatry 6:9, 263-269
- Varon J Jacobs (1981) Treating the progressive stages of Parkinson's disease. Postgrad Med 90(1):63-6, 69-71 (Electroconvulsive therapy may hold promise)
- Levy LA Savit JM and Hodes M (1983) Parkinsonism: improvement by electroconvulsive therapy.Arch Phys Med Rehabil 64(9):432-3 (case report)
- Lebensohn ZM and Jenkins RB (1975) Improvement of Parkinsonism in depressed patients treated with ECT. Am J Psychiatry 132(3):283-5 (2 case reports)
Multiple System Atrophy
Roane D,Rogers J, Helew L, and Jean Zarate J(2000),Electroconvulsive Therapy for Elderly Patients With Multiple System Atrophy, Am J Geriatr Psychiatry 8:5, 171-174
