title: Administration of electroconvulsive therapy for depression associated with deep brain stimulation in a patient with post-traumatic Parkinson's Disease: a case study.
abstract: BACKGROUND
  Deep brain stimulation (DBS) has been shown to be effective for parkinsonian symptoms poorly responsive to medications. DBS is typically well-tolerated, as are the maintenance battery changes. Here we describe an adverse event during a battery replacement procedure that caused rapid onset of severe depression.
  
  
  METHODS
  The patient is a 58-year-old woman who was in a serious motor vehicle accident and sustained a concussion with loss of consciousness. Within weeks of the accident she began developing parkinsonian symptoms that progressively worsened over the subsequent 10 years. Responding poorly to medications, she received DBS, which controlled her movement symptoms. Five years after initiating DBS, during a routine battery change, an apparent electrical event occurred that triggered the rapid onset of severe depression. Anti-seizure and antidepressant medications were ineffective, and the patient was offered a course of electroconvulsive therapy (ECT), which resulted in complete reversal of her depressive episode.
  
  
  CONCLUSIONS
  Parkinson's syndrome can be seen after a single closed head injury event. Post-traumatic parkinsonism is responsive to DBS; however, DBS has been associated with an infrequent occurrence of dramatic disruption in mood. ECT is a therapeutic option for patients who develop intractable depressive illness associated with DBS.
authors.affiliation: Department of Psychiatry, Laboratory for Neural Reconstruction, McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA, 02478, USA. mcunningham@mclean.harvard.edu.
authors.forename: Miles G
authors.initials: MG
authors.lastname: Cunningham
authors.affiliation: Department of Psychiatry, Laboratory for Neural Reconstruction, McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA, 02478, USA.
authors.forename: Golnaz
authors.initials: G
authors.lastname: Yadollahikhales
authors.affiliation: Department of Psychiatry, Brain Imaging Nanotechnology Group, McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA, 02478, USA.
authors.forename: Gordana
authors.initials: G
authors.lastname: Vitaliano
authors.affiliation: Department of Neurosurgery, Deep Brain Stimulator Center, University of Kentucky, 800 Rose St, Lexington, KY, 40538, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: van Horne
mesh_terms: D006259:Craniocerebral Trauma / Q000150:complications; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000379:methods; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010300:Parkinson Disease / Q000209:etiology / Q000523:psychology / Q000628:therapy; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome
keywords: Deep brain stimulation; Electroconvulsive therapy; Major depressive disorder; Parkinson’s Disease; Traumatic brain injury