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Neuroversion: using electroconvulsive therapy as a bridge to deep brain stimulation implantation.
Nolan R Williams1, Greg Sahlem2, Jaspreet Pannu1
1a Department of Psychiatry , Stanford University , Stanford , CA , USA.
Neurocase
|April 6, 2017
Summary
Right unilateral ultra-brief pulse electroconvulsive therapy (RUL UBP ECT) safely bridges patients with Parkinson's disease and deep brain stimulation (DBS) implants to surgery, resolving psychiatric symptoms without cognitive side effects.
Area of Science:
- Neurology
- Psychiatry
- Neurosurgery
Background:
- Parkinson's disease (PD) presents with neuropsychiatric symptoms.
- Electroconvulsive therapy (ECT) treats these symptoms but is avoided with deep brain stimulation (DBS) due to device/cognitive concerns.
- Right unilateral ultra-brief pulse (RUL UBP) ECT offers a better cognitive profile.
Observation:
- Three PD patients with DBS electrodes experienced psychiatric decompensation before planned surgery.
- RUL UBP ECT was administered to stabilize symptoms.
- This intervention served as a "bridge" to neurosurgery.
Findings:
- RUL UBP ECT was successfully used in patients with DBS implants.
- All patients showed symptom resolution (psychosis, depression, anxiety).
- No apparent cognitive side effects were observed.
Implications:
- RUL UBP ECT is a viable treatment for psychiatric decompensation in PD patients with DBS.
- This neuromodulatory approach can convert unstable patients into surgical candidates.
- It offers an alternative to managing severe psychiatric symptoms in this complex population.