ECT for Parkinson's?

Mark Guttman and associates,1 in their review of diagnosis and management of Parkinson's disease, make no reference to electroconvulsive therapy (ECT) as an option for patients with insufficient response to pharmacotherapy. The most contemporary and authoritative review of psychiatric practice in this field2 strongly endorses the use of ECT for the management of refractory Parkinson's disease, citing numerous references from the neurology and psychiatry literature in support of this endorsement. Many psychiatrists who administer ECT are aware of this literature. I would appreciate the authors' comments on the available evidence for the effectiveness of ECT in Parkinson's disease. If warranted, ECT should then be given its appropriate place in the treatment algorithm for this illness. B.A. Martin Head, ECT Service Centre for Addiction and Mental Health Toronto, Ont.