Electroconvulsive therapy in drug-induced psychiatric states and neuroleptic malignant syndrome.
In the late-stage idiopathic Parkinson's disease (IDP), comorbid conditions such as depression and drug-induced psychosis may be observed. A patient with Parkinson disease, major depression, and paranoid psychosis who developed neuroleptic malignant syndrome (NMS) as the result of the sudden termination of high-dose (1200 mg/d) levodopa treatment is presented in this report. Because the patient did not respond to other treatment modalities, electroconvulsive therapy (ECT) was applied, and a rapid improvement was observed both in the patient's NMS and also in Parkinson's and psychiatric symptoms, with no additional side effects other than transient post-ictal confusions. The application of ECT allowed the patient to remain stable for a 5-year period with a quite low dose of levodopa (300 mg/d). Later, the patient had two episodes of depressive and psychotic symptoms, which were again successfully treated with the ECT. We suggest that ECT might be an effective and life-saving therapy in patients with severe, drug-resistant NMS.
Ozer
Feriha
F
Department of Neurology, Bakirkoy Neurology Center, Istanbul, Turkey. ffozer@yahoo.com
Meral
Hasan
H
Aydin
Betul
B
Hanoglu
Lutfu
L
Aydemir
Tuba
T
Oral
Timucin
T
D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000009:adverse effects; D015259:Dopamine Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D004334:Drug Administration Schedule; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage* / Q000009:adverse effects*; D008875:Middle Aged; D009459:Neuroleptic Malignant Syndrome / Q000150:complications / Q000628:therapy*; D010300:Parkinson Disease / Q000188:drug therapy; D011605:Psychoses, Substance-Induced / Q000150:complications / Q000628:therapy*
D000978:Antiparkinson Agents; D015259:Dopamine Agents; D007980:Levodopa