Treatment of Multiple System Atrophy with Electroconvulsive Therapy (ECT) (P03.025)

OBJECTIVE: Evaluate the efficacy of ECT treatment in patients with MSA. BACKGROUND: MSA is a progressive neurodegenerative disorder characterized by widespread neuronal loss and gliosis, and reduced GDNF (glial derived neurotrophic factor) levels. ECT could provide neuroprotection through enhancement of striatal dopamine D1 and D3 receptor binding and increase in GDNF and perhaps brain derived neurotrophic factor (BDNF). DESIGN/METHODS: Three patients with MSA at mid-disease with limited ambulation and age 40-80 yo were enrolled in a 6-week trial of twice weekly ECT. Exclusions included: dementia, pregnancy, coexisting serious neurologic disorder, unstable or newly diagnosed medical or psychiatric disorder. Functional outcome measures: motor function with United Multiple System Atrophy Rating Scale (UMSARS); a combined history and examination tool; brief Composite Autonomic Symptom Scale (COMPASS); autonomic testing; CSF and serum levels of GDNF and BDNF. RESULTS: UMSARS Part I historical review scores: overall improvement 3/3. UMSARS Part II motor function: improvement 2/3 and mild worsening in 1. UMSARS part III autonomic symptoms: improved 2/3. UMSARS part IV global disability score: mild improvement 2/3. Autonomic testing did not show clear improvement and COMPASS was equivocal. Serum and CSF BDNF and GDNF levels did not show a consistent trend. CONCLUSIONS: ECT produced some functional improvement which did not correlate with increases in GDNF or BDNF, as had been hypothesized. The study was limited by small sample size and short follow-up which may change with a larger series and longer duration of ECT. A larger, multicenter trial would be required to determine the role of ECT in MSA. Supported by: Case CTSI grant. Disclosure: Dr. Husain has nothing to disclose. Dr. Ialacci has nothing to disclose. Dr. Walter has received personal compensation for activities with Deringer-Ney, Inc., Medtronic, Inc., Boehringer Ingelheim Pharmaceuticals, Inc. and Teva Neuroscience as a speaker, consultant and/or participant on an advisory board. Dr. Miller has nothing to disclose. Dr. Gao has nothing to disclose. Dr. Chelimsky has nothing to disclose. Dr. Chelimsky has received research support from the National Institute of Diabetes and Digestive and Kidney Diseases.