Objective: Through a single site case series, we investigate the use and effectiveness of electroconvulsive therapy (ECT) for the treatment of refractory psychiatric symptoms in Huntington’s Disease (HD) patients. We also review existing literature and compile past cases of ECT use in the HD population.

Background: Psychiatric symptoms contribute significantly to patient morbidity and caregiver burden in HD. [1] It also adds to mortality in the disease with suicide accounting for 5.7 out of every 100 deaths in HD, 4-8 times the rate of the general population. [2,3] Although ECT has been used as a strategy for the treatment of medication-refractory mood and psychotic symptoms since the mid-20th century, there is a paucity of literature on its use in HD and no standardized guideline or protocol for its use in this population. [4]

Method: We first compiled and summarized the existing cases of ECT use in HD described in the literature. Then through a single-center retrospective analysis, we review de-identified patient details, ECT course, and symptom response in HD patients treated with ECT for medication-resistant mood symptoms between 2016-2018.

Results: A review of the literature resulted in nineteen past cases of ECT use for refractory psychiatric symptoms in HD, with eighteen of the nineteen patients having improvements in symptoms by discharge. Through this case series, we add four additional patient cases to the evidence of ECT use in the field. All four patients had improvements in depression, agitation, and suicidal ideation leading to successful hospital discharge, with three of the four patients continuing maintenance ECT post-discharge. Two of the four patients also had psychotic symptoms which improved with ECT.

Conclusion: This case series adds to the small body of literature documenting the effectiveness of ECT on refractory psychiatric symptoms in HD. Larger scale, prospective studies are needed to best quantify the benefits of ECT and assess optimal methods to maximize effectiveness. A standardized ECT protocol would lead to a more universal, evidence-based approach to its use in this population.

References: 1. Jensen P, Sorensen SA, Fenger K, Bolwig TG. A study of psychiatric morbidity in patients with Huntington’s disease, their relatives, and controls. Admissions to psychiatric hospitals in Denmark from 1969 to 1991. Br J Psychiatry. 1993;163:790-7. 2. Farrer LA. Suicide and attempted suicide in Huntington disease: implications for preclinical testing of persons at risk. Am J Med Genet. 1986;24(2):305-11. 3. Schoenfeld M, Myers RH, Cupples LA, Berkman B, Sax DS, Clark E. Increased rate of suicide among patients with Huntington’s disease. J Neurol Neurosurg Psychiatry. 1984;47(12):1283-7. 4. Anderson KE, van Duijn E, Craufurd D, Drazinic C, Edmondson M, Goodman N, et al. Clinical Management of Neuropsychiatric Symptoms of Huntington Disease: Expert-Based Consensus Guidelines on Agitation, Anxiety, Apathy, Psychosis and Sleep Disorders. J Huntingtons Dis. 2018;7(3):355-66.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/electroconvulsive-therapy-ect-an-effective-option-for-the-treatment-of-medication-resistant-psychiatric-symptoms-in-huntingtons-disease-a-case-series-and-review-of-the-literature/