Objective: To report an evidence for safety of ECT in patients with DBS in place.

Background: We report a case of bilateral electroconvulsive therapy (ECT) conjointly done in a patient with a deep brain stimulator (DBS) in place for Parkinson’s disease (PD), to show that it can be accomplished safely and effectively. There is currently limited data available on the use of ECT in the presence of the DBS.

Methods: We report the successful treatment of an episode of major depression with psychotic features and severe suicidality with electroconvulsive therapy (ECT) in a 48-year-old male with Parkinson’s disease who had a bilateral subthalamic nucleus deep-brain stimulator (DBS) in place five years prior to presentation at our hospital. We used the Thymatron IV System, and a stimulus of 15% of maximum charge and 0.5 PW was utilized based on evidence published in Clinical Manual of Electroconvulsive Therapy by Mehul Mankad, M.D, et. al. related to known seizure thresholds and to ensure adequate dosing in a male BL patient. His last treatment was at a stimulus of 100% maximum charge and lasted 51 seconds on EEG with a 42 second motor seizure. This was the patient’s 13th treatment and only 11th seizure.

Results: ECT was effectively and safely utilized to treat the patient’s depression as well as psychosis without harming the patient or damaging the DBS hardware. A Montgomery Asberg Depression Rating Scale (MADRS), Spanish version, was done on a weekly basis to assess improvements on mood. The first MADRS performed on 5/22/15 was 47. By treatment #11 and seizure # 9 the MADRS score had decreased to 8. The patient received a total of 13 treatments. The patient’s Parkinson’s symptoms also decreased and he required less medication upon discharge from the hospital.

Conclusions: As DBS and ECT are becoming more commonplace as a therapeutic treatment for patient’s with PD it is our goal is to add to the growing body of evidence about the safety and efficacy of ECT in patients with DBS as well as provide a suggested protocol for treatments. The technique herein described may be applicable to other patients who have co morbid PD with DBS who need ECT.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/suggested-protocol-for-electroconvulsive-therapy-for-depression-in-a-parkinsons-disease-patient-with-a-deep-brain-stimulator-a-case-report/