Electroconvulsive Therapy for Parkinson’s Disease with Depression and Neuroleptic Malignant Syndrome: A Case Report

Parkinson’s disease is often complicated by psychiatric symptoms. Psychiatrists are caught in a dilemma between such symptoms and physical treatment since Parkinson’s disease sometimes shows treatment resistance based on pharmaco-logical treatment-induced dopamine dysfunction. Here, we report on a 64-year-old woman with a 15-year history of Parkinson’s disease with stage IV severity based on the Hoehn and Yahr scale. She was admitted to our hospital with a diagnosis of major depressive disorder with psychotic features. Unfortunately, her treatment course for depression was complicated by neuroleptic malignant syndrome. Because we were concerned about the persistence of her depres-sive symptoms, the risk of psychotropic drugs causing adverse effects, and progressive disuse syndrome, we administered modified electroconvulsive therapy. Her symptoms of neuroleptic malignant syndrome and depression sufficiently im-proved after five sessions of modified electroconvulsive therapy. Additionally, the primary motor symptoms of her Parkinson’s disease also markedly improved. The improvement of neuroleptic malignant syndrome and her motor symp-toms based on dopamine dysfunction can be explained by electroconvulsive therapy’s effectiveness in activating dop-amine neurotransmission. Besides, the marked improvement of her depressive episode with psychotic features was pre-sumed to involve dopamine receptor activation and regulation. Because advanced Parkinson’s disease can sometimes be refractory to treatment based on pharmacological treatment-induced dopamine dysfunction, psychiatrists often have difficulty treating psychiatric symptoms; electroconvulsive therapy may stabilize the dopaminergic system in such cases, presenting a possible non-pharmacologic treatment option for Parkinson’s disease.