Efficacy, safety and predictors of response to electroconvulsive therapy in Lewy body disease

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BACKGROUND AND OBJECTIVES: Severe neuropsychiatric symptoms, specifically affective, psychotic, and catatonic symptoms, are common in Lewy body disease (LBD). As pharmacotherapy is often limited by poor efficacy and intolerance, alternative treatments are needed. While electroconvulsive therapy (ECT) has shown promise, systematic data on its use in LBD remain scarce. This study aimed to evaluate the efficacy and safety of ECT in LBD and identify predictors of response. METHODS: We compared 40 patients with LBD with 33 with schizophrenia and 24 with affective disorders who received ECT between 2012 and 2023. The primary outcome was short-term efficacy, measured by the Clinical Global Impressions-Improvement (CGI-I) scale upon completion of the ECT course. Long-term outcomes were assessed using 6-month and 2-year psychiatric readmission rates. Ordinal logistic regression was used to identify clinical predictors of response in the LBD group. RESULTS: Short-term efficacy in LBD was comparable to schizophrenia but lower than in affective disorders (median CGI-I: 2 vs. 1). In LBD, psychosis and catatonia predicted a favorable response. While 6-month psychiatric readmission rates were similar across groups, the 2-year rate was highest in LBD (61.5%). ECT was well-tolerated, with no serious adverse events; transient amnesia was the most common side effect. CONCLUSION: ECT is effective and safe for severe neuropsychiatric symptoms in LBD, particularly for psychosis or catatonia. Although its short-term efficacy may be less pronounced than in primary affective disorders, it represents a valuable alternative when pharmacotherapy is challenging. Further research is warranted to confirm long-term benefits and optimize patient selection.

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