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

BackgroundSevere, treatment-resistant psychiatric symptoms are common in Lewy body disease (LBD). As pharmacotherapy is often limited by poor efficacy and adverse effects, alternative treatments are needed. While electroconvulsive therapy (ECT) has shown promise, systematic data on its use in LBD remain scarce. AimsTo evaluate the efficacy and safety of ECT in patients with LBD and identify predictors of a favorable response. MethodWe compared 40 patients with LBD to 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. Long-term outcomes were assessed via 6-month and 2-year readmission rates. An ordinal logistic regression analysis was used to identify clinical predictors of response, including target symptoms (psychosis, catatonia, and depression), in the LBD group. ResultsShort-term efficacy in the LBD group was comparable to that in the schizophrenia group but lower than in the affective disorders group (median CGI-I: 2 vs. 1, p < 0.05). Within the LBD group, the regression analysis revealed that psychosis and catatonia were significant predictors of a favorable response (p = 0.044). While 6-month readmission rates were similar across groups, the 2-year rate was highest among LBD patients (61.5%). ECT was well-tolerated, with no serious adverse events and transient amnesia as the most common side effect. ConclusionsECT is an effective and safe treatment for severe psychiatric symptoms in LBD, particularly for patients with psychosis or catatonia. Although its short-term efficacy may be less pronounced than in affective disorders, it represents a valuable therapeutic alternative when pharmacotherapy is challenging. Further research is warranted to confirm long-term benefits and optimize patient selection.