Unilateral ultra‐brief pulse electroconvulsive therapy for depression in Parkinson's disease

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Parkinson's disease (PD) is the quintessential neuropsychiatric condition with motoric impairments occurring alongside common comorbidities such as depression, apathy, psychosis, cognitive impairment, and impulse control disorders.1 Unfortunately, efficacious pharmacological treatment options are often limited by these neuropsychiatric symptoms,2 necessitating the use of brain stimulation technologies such as electroconvulsive therapy (ECT). ECT significantly reduces mortality in patients with treatment refractory neuropsychiatric disease.3 Furthermore, ECT is not only effective in treating depression and psychosis in PD, but it also has a profound and long‐lasting anti‐Parkinsonian effect on motoric function in the range of weeks to months.5 The use of ECT in patients with PD, however, has been limited due to significant cognitive side effects, particularly delirium, induced by older forms of ECT.6
Sackeim et al.7 have demonstrated that ECT utilizing an ultra‐brief pulse (UBP) width targeted unilaterally to the right cerebral hemisphere is as efficacious as bilateral ECT in treating depression but with substantially reduced severity of adverse cognitive effects. To date, no one has explored the safety and potential efficacy of this new form of ECT for the PD population. As the pathophysiology of PD‐related depression may be unique,8 and given the increased cognitive burden inherent in advanced PD, it is prudent that right unilateral ultra‐brief pulse (RUL UBP) ECT be evaluated in the PD population before widespread adoption of this treatment approach.
This small open‐label study evaluated the safety, feasibility, and preliminary efficacy of RUL UBP ECT in six inpatient participants with PD and treatment‐resistant depression or psychosis or both. In concordance with the known effects of conventional ECT in PD,5 we hypothesized that patients would significantly improve in both mood and motor function with RUL UBP ECT. We also hypothesized that acute and subacute adverse cognitive effects of RUL UBP ECT would be substantially reduced in severity compared to published side effects in patients receiving conventional bilateral ECT.
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