Electroconvulsive therapy for Parkinson's disease-related apathy: A case report

Nonmotor symptoms are a critical focus in the management of Parkinson's disease (PD). Apathy is defined as a quantitative reduction in goal-directed activity, characterized by diminished initiative, interest, and emotional expression or responsiveness. It affects approximately 40% of patients with PD, severely impairing daily functioning and quality of life. Although electroconvulsive therapy (ECT) is well established for alleviating depressive symptoms in patients with PD, its efficacy in treating apathy remains largely unexplored.

We report the case of a 54-year-old man diagnosed with PD at age 49, whose motor symptoms were well controlled with optimized pharmacotherapy. However, at age 53, he developed profound apathy, characterized by a notable reduction in spontaneous movement and emotional expression. Given the lack of response to pharmacological adjustments, including a trial of venlafaxine, modified ECT (m-ECT) was initiated. The patient underwent 10 m-ECT sessions over 5 weeks (twice weekly) using propofol and succinylcholine. Following treatment, his apathy scale score improved substantially from 32 to 12, with no adverse effects on cognitive function.

This case highlights the potential efficacy of ECT for PD-related apathy. Further research is needed to elucidate its underlying mechanisms and assess the long-term outcomes of ECT in managing nonmotor symptoms in PD.