Response of the Parkinsonian Symptoms of Multiple System Atrophy to ECT
Mr. A was a 78-year-old man who at the age of 72 had developed bradykinesia, rigidity, resting tremor, ataxia, orthostatic hypotension, and urinary incontinence. His parkinsonian symptoms were poorly responsive to carbidopa and levodopa; Mr. A was unable to transfer (i.e., move from his bed to a chair) or walk independently. At the age of 75, he had developed antidepressant-refractory major depression.Following outpatient neurology and psychiatric evaluations, Mr. A was referred for inpatient psychiatric treatment. Upon admission, he reported a depressed mood, anhedonia, anergia, frequent nocturnal awakenings, decreased appetite, feelings of guilt, and a fixed belief that “people were plotting” against him. His score on the Mini-Mental State examination) was 27 of 30; on the Hamilton Rating Scale for Depression, his score was 41. Mr. A’s diagnosis was major depression with psychotic features; following informed consent, he received eight bilateral ECT treatments (EEG seizure duration=409 seconds) without complication. Carbidopa and levodopa (25 and 100 mg, respectively; two and one-half tablets q.i.d) were continued throughout the ECT course. Following the second treatment, improvement in bradykinesia was noted. After the fifth treatment, Mr. A was reevaluated by the neurology service, and the degree of rigidity, resting tremor, and gait instability was improved. Specifically, Mr. A was able to transfer himself from one position or station to another and walk with minimal assistance. Improvement in his parkinsonian symptoms occurred before the antidepressant effects of ECT were clinically evident. His post-ECT scores on the Mini-Mental State and the Hamilton depression scale were 24 of 30 and 7, respectively. Six bilateral maintenance ECT treatments were administered during the 4 months following discharge. Improvement in parkinsonian symptoms was sustained, and Mr. A was able to transfer himself from one position or station to another and walk independently.
References
Information & Authors
Information
Published In
History
Authors
Metrics & Citations
Metrics
Citations
Export Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
There are no citations for this item
View Options
View options
PDF/ePub
View PDF/ePubGet Access
Login options
Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.
Personal login Institutional Login Open Athens loginNot a subscriber?
PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.
Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).