Limited usefulness of electroconvulsive therapy in progressive supranuclear palsy

Objective: To perform a pilot study of the efficacy of electroconvulsive therapy (ECT) in improving motor function in progressive supranuclear palsy (PSP). Background: Few effective treatments are available for PSP. Tricyclic antidepressants and idazoxan (which increases central norepinephrine) have shown benefits in small clinical trials, and dopaminergic therapy has been reported, anecdotally, to be beneficial. ECT exerts effects on all of these transmitter systems, possibly by inducing increased receptor sensitivity. We postulated that by sensitizing dopaminergic and noradrenergic systems, ECT might improve motor symptoms of PSP. Methods: Five patients with clinically diagnosed PSP were evaluated before and after nine ECT treatments using the Unified Parkinson's Disease Rating Scale (UPDRS) and an apomorphine challenge to assess dopaminergic responsiveness, Results: No permanent side effects were seen. Transient side effects included confusion in all patients, worsening of speech and swallowing in two, and dystonic posturing of the foot in one, One patient experienced a dramatic response (going from a completely wheelchair-bound state to independent ambulation), two were mildly improved, and two were unchanged. Conclusions: Although ECT may ameliorate motor symptoms in PSP, the long hospitalization and the significant treatment-induced confusion limit the usefulness of this technique.