Electroconvulsive Therapy (ECT) for the Treatment of Refractory Depression in Huntington's Disease Patients: A Case Series

Objective: In this single site case series, we review electroconvulsive therapy (ECT) use for four Huntington’s Disease (HD) patients with medication-refractory depression to better assess the utility of ECT in this population. Background: HD is a progressive neurodegenerative disease characterized by involuntary movements, cognitive symptoms, and neuropsychiatric decline. Neuropsychiatric symptoms contribute to considerable morbidity as well as mortality in the disease with suicide accounting for 5.7 out of every 100 deaths in HD patients, 4–8 times the rate of the general population. ECT has been used as a treatment for severe or medication-refractory mood disorders and catatonia since the mid-20th century. However, it is not standard of care for the management of refractory symptoms in HD, and there is a paucity of published literature on ECT use in this population. Some case studies have demonstrated ECT’s positive effect on depression and agitation in HD, but the data is limited. Design/Methods: We performed a single-center retrospective analysis of ECT cases for refractory mood symptoms in HD at Northwestern Memorial Hospital from 2016–2018, reviewing de-identified patient details, presenting symptoms, ECT course details, and clinical response to ECT. Results: Four patients underwent inpatient ECT with three patients continuing maintenance therapy as an outpatient. They all had improvements in depression, agitation, and suicidal ideation leading to successful hospital discharge. Two of the four patients also had psychotic symptoms that also improved with ECT. One patient reported subjective improvement in cognitive and motor symptoms. Conclusions: This case series adds to the small body of case reports on the topic of ECT for HD. Larger scale, prospective studies are warranted to further investigate the specific role and protocol for the use of ECT in HD to establish a more universal, evidence-based approach to the use of ECT in refractory mood symptoms in this population. Disclosure: Dr. Smith has nothing to disclose. Dr. Nadkarni has nothing to disclose. Dr. Gausche has nothing to disclose. Dr. Bega has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Teva Pharmaceuticals, Neurocrine, Adamas. Dr. Bega has received personal compensation in an editorial capacity for Annals of Clinical and Translational Neurology.