Table 2. Use of ECT in other CNS conditions

Epilepsy   

ECT: excellent anticonvulsant property (125)

Used since 1940s (126)

For intractable medication-resistant epilepsy or status epilepticus (127)

ECT may cause prolonged or spontaneous seizures (128)

May need regular epilepsy medication (129), despite increase in seizure threshold (130)

Determine seizure threshold for ECT (131)

Dementia

Higher risk (21%) of transient post-ECT confusion (132–134), but remits spontaneously (136)

Affective benefits comparable to patients without dementia (135)

Extensive review found 73% positive response for depressive symptoms (136)

Subcortical dementias (for example Parkinson’s) respond better than cortical (for example Alzheimer’s)

Cognitive improvement in 29% due to alleviation of depression (136)

Parkinson’s disease (PD)

For medication-refractory, medication-intolerant patient with severe disability (137)

Useful in acute and continuation or maintenance phases (137)

Improves motor symptoms, especially the “on-off” phenomenon, independently of psychiatric symptoms (138–140)

Benefits persist for days to months and require less dopaminergic medication (141,142)

Post-ECT cognitive dysfunction and delirium minimized by levodopa dose reduction and starting with right unilateral ECT proceeding to bilateral if no response by third ECT (143,144).