title: Neuroversion: using electroconvulsive therapy as a bridge to deep brain stimulation implantation.
abstract: Parkinson's disease (PD) is a movement disorder with significant neuropsychiatric comorbidities. Electroconvulsive therapy (ECT) is effective in treating these neuropsychiatric symptoms; however, clinicians are reluctant to use ECT in patients with deep brain stimulation (DBS) implantations for fear of damaging the device, as well as potential cognitive side effects. Right unilateral ultra-brief pulse (RUL UBP) ECT has a more favorable cognitive side-effect profile yet has never been reported in PD patients with DBS implants. We present a case series of three patients with a history of PD that all presented with psychiatric decompensation immediately prior to planned DBS surgery. All three patients had DBS electrode(s) in place at the time and an acute course of ECT was utilized in a novel method to "bridge" these individuals to neurosurgery. The patients all experienced symptom resolution (psychosis and/or depression and/or anxiety) without apparent cognitive side effects. This case series not only illustrates that right unilateral ultra-brief pulse can be utilized in patients with DBS electrodes but also illustrates that this intervention can be utilized as a neuromodulatory "bridge", where nonoperative surgical candidates with unstable psychiatric symptoms can be converted to operative candidates in a manner similar to electrical cardioversion.
authors.affiliation: a Department of Psychiatry , Stanford University , Stanford , CA , USA.
authors.forename: Nolan R
authors.initials: NR
authors.lastname: Williams
authors.affiliation: b Department of Psychiatry , Medical University of South Carolina , Charleston , SC , USA.
authors.forename: Greg
authors.initials: G
authors.lastname: Sahlem
authors.affiliation: a Department of Psychiatry , Stanford University , Stanford , CA , USA.
authors.forename: Jaspreet
authors.initials: J
authors.lastname: Pannu
authors.affiliation: d Department of Neurosurgery , Medical University of South Carolina , Charleston , SC , USA.
authors.forename: Istvan
authors.initials: I
authors.lastname: Takacs
authors.affiliation: b Department of Psychiatry , Medical University of South Carolina , Charleston , SC , USA.
authors.forename: Baron
authors.initials: B
authors.lastname: Short
authors.affiliation: c Department of Neurology , Medical University of South Carolina , Charleston , SC , USA.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Revuelta
authors.affiliation: b Department of Psychiatry , Medical University of South Carolina , Charleston , SC , USA.|c Department of Neurology , Medical University of South Carolina , Charleston , SC , USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: George
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D004565:Electroconvulsive Therapy / Q000379:methods*; D004567:Electrodes, Implanted / Q000009:adverse effects / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000628:therapy*; D011618:Psychotic Disorders / Q000209:etiology* / Q000628:therapy*
keywords: Bridging; deep brain stimulation; electroconvulsive therapy; interventional psychiatry; neuroversion