Shock therapy's Parkinsonian potential.

Shock therapy's Parkinsonian potential

The surgical implanting of fetal tissue into the brains of people with Parkinson's disease has attracted much attention (see story, p.378), but a safer and cheaper treatment may exist, according to a report in the November AMERICAN JOURNAL OF PSYCHIATRY. That treatment is electrocshock therapy, also known as electroconvulsive therapy (ECT).

Parkinsonian symptoms, including tremors, muscle rigidity and difficulty in walking, improved markedly in seven patients with the disorder who underwent ECT for severe depression, say Richard Douyon of New York University School of Medicine and his colleagues. At a six-month follow-up, four patients maintained their improvement; the rest maintained it for up to six weeks after ECT ended. Each patient received an average of seven ECT treatments, but five significantly improved after only two treatments, the researchers say.

During the study, doeses of dopamine-enhancing drugs commonly given to Parkinson's patients were held constant. Deficits of dopamine, a chemical messenger in the brain, are considered a crucial cause of Parkinson's disease.

ECT also eased depression in all the patients. Electroshock is most commonly used with severely depressed patients who are suicidal or who fail to respond to antidepressant drugs.

Several other reports of ECT's effectiveness in Parkinson's patients--most of whom also suffered severe depression--have appeared over the past 25 years, says Richard Abrams of the University of Health Sciences/Chicago Medical School in North Chicago. Large, controlled studies of these effects are needed, Abrams writes in an editorial accompanying Douyon's article.

In the meantime, Abrams recommends a trial of ECT for all patients with severe or drug-resistant Parkinson's disease, particularly those with "on-off syndrome," a disorder linked to use of the anti-Parkinson drug levodopa and characterized by frequent, abrupt swings from mobility to total incapacitation. "Maintenance ECT" administered once or twice a month after initial electroshock sessions may keep Parkinsonian symptoms from returning, he adds. If administered in brief electrical pulses to the right side of the brain, maintenance ECT should interfere with memory less than drugs such as levodopa, Abrams says.