Back to top Open menu arrow
Purchase PDF

Save Save

Cite Cite

Reprints
Sections
METHODS RESULTS CONCLUSIONS Clinical Points
Primary Care Companion for CNS Disorders Primary Care Companion for CNS Disorders

The Primary
Care Companionfor CNS Disorders
Access icon

Systematic Review March 11, 2021

Electroconvulsive Therapy in Multiple Sclerosis: A Review of Current Evidence

;

Prim Care Companion CNS Disord 2021;23(2):20r02717

ABSTRACT

Objective: To review the published literature over the last 5 years on the use of electroconvulsive therapy (ECT) in multiple sclerosis (MS), focusing on efficacy, safety, and tolerability. MS commonly has neuropsychiatric comorbidity. ECT is used in MS for severe and life-threatening forms of mental illness when other treatment options have failed or when a rapid response is required.

Data Sources: English-language literature published in the last 5 years (January 2015–June 2, 2020) was searched using the terms: ECT, electroconvulsive therapy, shock therapy, electroshock therapy, electroconvulsive therapies, multiple sclerosis, chronic progressive multiple sclerosis, acute relapsing multiple sclerosis, and multiple sclerosis, relapsing and remitting. KnowledgeShare, a National Health Service library application providing updates on evidence-based practice, was used along with EMBASE, PsycInfo, MEDLINE, PubMed, the TRIP database (which offers a complete and updated list of evidence-based online resources), HDAS (Healthcare Databases Advanced Search), CRDWeb (Centre for Reviews and Dissemination), and the Cochrane Library. Reference lists of articles identified in the search were also reviewed.

Study Selection: Our initial search revealed 30 articles of potential relevance. However, after individually evaluating these articles, only 6 case studies and 1 review article detailing the use of ECT in MS were included.

Data Extraction: The studies were analyzed by both authors to obtain clinical information relevant to meeting the objectives of the review.

Data Synthesis: The efficacy and safety in using ECT for MS is derived only from case series and case reports. There were no controlled trials or systematic reviews, and the evidence collated was of low quality.

Conclusions: The consensus is that ECT is an effective treatment for specific mental disorders in MS including catatonia. We have used ECT successfully in our clinic for patients with MS. However, there are concerns about the potential effects of ECT on neurologic and cognitive function. There are also possible risks with using anesthetic agents and particularly neuromuscular blockers.

  1. Ron MA. The neuropsychiatry of multiple sclerosis. BJPsych Advances. 2018;24(3):178–187. CrossRef
  2. Thompson AJ. A much-needed focus on progression in multiple sclerosis. Lancet Neurol. 2015;14(2):133–135. PubMed CrossRef NLM
  3. Moghadasi AN, Pourmand S, Sharifian M, et al. Behavioral neurology of multiple sclerosis and autoimmune encephalopathies. Neurol Clin. 2016;34(1):17–31. PubMed CrossRef NLM
  4. Pérez LP, González RS, Lázaro EB. Treatment of mood disorders in multiple sclerosis. Curr Treat Options Neurol. 2015;17(1):323. PubMed CrossRef NLM
  5. Ferrier NI, Waite J. ECT in Neuropsychiatric Disorders. In: Waite J, ed. The ECT Handbook. 4th ed. Ferrier, IN: Cambridge University Press; 2020:96–108.
  6. Feinstein A. An examination of suicidal intent in patients with multiple sclerosis. Neurology. 2002;59(5):674–678. PubMed CrossRef NLM
  7. Chwastiak LA, Ehde DM. Psychiatric issues in multiple sclerosis. Psychiatr Clin North Am. 2007;30(4):803–817. PubMed CrossRef NLM
  8. Taylor D, Barnes TRE, Young AH. Drug treatment of psychiatric symptoms occurring in the context of other disorders. In: Maudsley Prescribing Guidelines. 13th ed. Hoboken, NJ: Wiley Blackwell; 2018:679–728.
  9. Steen K, Narang P, Lippmann S. Electroconvulsive therapy in multiple sclerosis. Innov Clin Neurosci. 2015;12(7-8):28–30. PubMed NLM
  10. Kalali A. Editor’s message: issue highlights, July–August 2015. Innov Clin Neurosci. 2015;12(7–8):3.
  11. Rasmussen KG, Keegan BM. Electroconvulsive therapy in patients with multiple sclerosis. J ECT. 2007;23(3):179–180. PubMed CrossRef NLM
  12. Mattingly G, Baker K, Zorumski CF, et al. Multiple sclerosis and ECT: possible value of gadolinium-enhanced magnetic resonance scans for identifying high-risk patients. J Neuropsychiatry Clin Neurosci. 1992;4(2):145–151. PubMed CrossRef NLM
  13. Pontikes TK, Dinwiddie SH. Electroconvulsive therapy in a patient with multiple sclerosis and recurrent catatonia. J ECT. 2010;26(4):270–271. PubMed CrossRef NLM
  14. Urban-Kowalczyk M, Rudecki T, Wróblewski D, et al. Electroconvulsive therapy in patient with psychotic depression and multiple sclerosis. Neurocase. 2014;20(4):452–455. PubMed CrossRef NLM
  15. Oligmueller J, Sharma A, Egbert M, et al. Safety of electroconvulsive therapy in treatment-refractory depression in the setting of multiple sclerosis. J ECT. 2019;35(3):e36–e37. PubMed CrossRef NLM
  16. Clayton AM, Howard J, Dobbs B, et al. Remotely supervised transcranial direct current stimulation after ECT improves mood and cognition in a patient with multiple sclerosis: a case study. J ECT. 2018;34(1):e15. PubMed CrossRef NLM
  17. Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967;6(4):278–296. PubMed CrossRef NLM
  18. Harley JA, Peebles C, Porter RJ. Electroconvulsive therapy for catatonia secondary to neuroleptic malignant syndrome in a patient with multiple sclerosis. Aust N Z J Psychiatry. 2019;53(7):703–704. PubMed CrossRef NLM
  19. Rocuronium 10 mg/ml solution for injection/infusion. emc website. https://www.medicines.org.uk/emc/product/553/smpc.
  20. Narita Z, Satake N, Sato W, et al. Possible effects of electroconvulsive therapy on refractory psychosis in primary progressive multiple sclerosis:a case report. Neuropsychopharmacol Rep. 2018;38(2):92–94. PubMed CrossRef NLM
  21. Drane A, Agalawatta N, Lyndon W, et al. Seizure, sclerosis or space-occupying lesions? Aust N Z J Psychiatry. 2017;51(1):101. PubMed CrossRef NLM
  22. Palm U, Ayache SS, Padberg F, et al. Non-invasive brain stimulation therapy in multiple sclerosis: a review of tDCS, rTMS and ECT results. Brain Stimul. 2014;7(6):849–854. PubMed CrossRef NLM
  23. Tran T, Tibrewal P, Dhillon R, et al. Is electroconvulsive therapy safe in multiple sclerosis? Aust N Z J Psychiatry. 2015;49(10):942–942. PubMed CrossRef NLM
  24. Nag K, Singh DR, Shetti AN, et al. Sugammadex: a revolutionary drug in neuromuscular pharmacology. Anesth Essays Res. 2013;7(3):302–306. PubMed CrossRef NLM
  25. Semkovska M, McLoughlin DM. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry. 2010;68(6):568–577. PubMed CrossRef NLM
  26. Kirov GG, Owen L, Ballard H, et al. Evaluation of cumulative cognitive deficits from electroconvulsive therapy. Br J Psychiatry. 2016;208(3):266–270. PubMed CrossRef NLM

About the Authors

Buy PDF for $40

Please sign in or purchase this PDF for $40.

Save Save

Cite Cite

Vol 27 • 2025 • Number 3

Read the Current Issue

Original Research

Conflict Mediation by CBT

Systematic Review

Psychiatric Adverse Effects of Hydroxychloroquine

Review Article

Efficacy of GLP-1 Agonists in Mental Disorders

Rounds in the General Hospital

Time-Limited Teaching of Psychiatry to Medical Students

Rounds in the General Hospital

Multimodal Approaches to Pain Management

Rounds in the General Hospital

Sequelae of Adverse Childhood Experiences
View current Issue

Watch the New PsychCase360

Explore two real-world schizophrenia cases

Subscribe to read
more articles

Subscribe