Abstract Details

Title Treatment of Multiple System Atrophy with Electroconvulsive Therapy (ECT)

Topic Autonomic Disorders

Presentation(s) IN11 - (-)

Poster/Presentation
Number 005

Objective

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.

Authors/Disclosures
Asima Husain, MD PRESENTER	No disclosure on file
J Renfroe, MD (Child Neurology Center of Northwest Florida)	Dr. Renfroe has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Engage Therapeutics. Dr. Renfroe has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Eisai. Dr. Renfroe has received intellectual property interests from a discovery or technology relating to health care.
Patricia K. Coyle, MD, FAAN (SUNY At Stony Brook)	Dr. Coyle has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Accordant. Dr. Coyle has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Coyle has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Sanofi Genzyme. Dr. Coyle has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly and Company. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GlaxoSmithKline. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Horizon Therapeutics. Dr. Coyle has received personal compensation in the range of $500-$4,999 for serving as a Consultant for LabCorp. Dr. Coyle has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD Serono. Dr. Coyle has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Mylan. Dr. Coyle has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Coyle has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Viatris. Dr. Coyle has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen. The institution of Dr. Coyle has received research support from CorEvitas LLC. The institution of Dr. Coyle has received research support from Genentech/Roche. The institution of Dr. Coyle has received research support from NINDS. The institution of Dr. Coyle has received research support from Sanofi Genzyme. The institution of Dr. Coyle has received research support from Celgene.
	No disclosure on file
Benjamin L. Walter, MD (Cleveland Clinic)	Dr. Walter has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Acorda. Dr. Walter has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Lundbeck. Dr. Walter has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Medtronic. Dr. Walter has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Teva. Dr. Walter has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbott.
Benjamin R. Miller, MD (University of Minnesota)	The institution of Dr. Miller has received research support from StrokeNET.
	No disclosure on file
	No disclosure on file
Thomas C. Chelimsky, MD (Medical College of Wisconsin)	Dr. Chelimsky has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Proctor & Gamble. Dr. Chelimsky has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Various Legal Firms. Dr. Chelimsky has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Various Legal Firms. Dr. Chelimsky has received stock or an ownership interest from PainSTakers, LLC. The institution of Dr. Chelimsky has received research support from NIDDK. The institution of Dr. Chelimsky has received research support from Advancing a Healthier Wisconsin.

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