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Case Reports
. 2023 Apr 20;23(1):279.
doi: 10.1186/s12888-023-04759-z.

Bifrontal electroconvulsive therapy leads to improvement of cerebral glucose hypometabolism in frontotemporal dementia with comorbid psychotic depression - a case report

Sebastian Schröder  1 , Lena Bönig  2 , Phileas Johannes Proskynitopoulos  1 , Eva Janke  1 , Johannes Heck  3 , Nima Mahmoudi  4 , Adrian Groh  1 , Georg Berding  5 , Felix Wedegärtner  1 , Stephanie Deest-Gaubatz  1 , Hannah Benedictine Maier  1 , Stefan Bleich  1 , Helge Frieling  1 , Martin Schulze Westhoff  6
Affiliations
Case Reports

Bifrontal electroconvulsive therapy leads to improvement of cerebral glucose hypometabolism in frontotemporal dementia with comorbid psychotic depression - a case report

Sebastian Schröder et al. BMC Psychiatry. .

Abstract

Background: Differentiating depression and dementia in elderly patients represents a major clinical challenge for psychiatrists. Pharmacological and non-pharmacological treatment options for both conditions are often used cautiously due to fear of adverse effects. If a clinically indicated therapy is not initiated due to fear of adverse effects, the quality of life of affected patients may significantly be reduced.

Case presentation: Here, we describe the case of a 65-year-old woman who presented to the department of psychiatry of a university hospital with depressed mood, pronounced anxiety, and nihilistic thoughts. While several pharmacological treatments remained without clinical response, further behavioral observation in conjunction with 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) revealed the diagnosis of frontotemporal dementia (FTD). To counter the pharmacological treatment resistance of psychotic depression, we decided to perform electroconvulsive therapy (ECT). Remarkably, ten sessions of ECT yielded an almost complete remission of depressive symptoms. In addition, the patient's delusional ideas disappeared. A follow-up 18F-FDG PET/CT after the ECT series still showed a frontally and parieto-temporally accentuated hypometabolism, albeit with a clear regression compared to the previous image. The follow-up 18F-FDG PET/CT thus corroborated the diagnosis of FTD, while on the other hand it demonstrated the success of ECT.

Conclusions: In this case, ECT was a beneficial treatment option for depressive symptoms in FTD. Also, 18F-FDG PET/CT should be discussed as a valuable tool in differentiating depression and dementia and as an indicator of treatment response.

Keywords: 18F-FDG PET/CT; Depression; ECT; Frontotemporal dementia.

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Conflict of interest statement

HBM took part in an educational event sponsored by Livanova. All other authors declare that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Magnetic resonance imaging (MRI) displaying bihemispheric, supratentorial T2 white matter hyperintensities
Fig. 2
Fig. 2
18F-FDG PET/CT depicting improvement of frontally accentuated glucose hypometabolism after treatment with ECT. Figure 2A indicates that the Standardized Uptake Value (SUV) peak in the CNS before therapy was 7.0, afterwards 9.7. In the tomograms scaled to the maximum of the follow-up study, the lower uptake before therapy is visible in several brain regions (cerebral cortex, basal ganglia, cerebellum). Figure 2B maps the Statistical Parametric Mapping (SPM) comparison of the respective studies to a control population. It shows before therapy a significantly more extended, contiguous cluster of suprathreshold voxels (p < 0.001) with significant hypometabolism, whereas after therapy four non-contiguous, significantly smaller clusters could be found
See this image and copyright information in PMC

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