Electroconvulsive Therapy for Behavioral, Mood, and Catatonic Symptoms in Patients With Frontotemporal Dementia

Frontotemporal dementia (FTD) encompasses a group of clinically, neuropathologically, and genetically heterogeneous disorders characterized by atrophy in the frontal and anterior temporal lobes. Psychiatric and behavioral symptoms are common throughout the course of FTD, and pharmacological treatments show limited efficacy. In this review, we analyzed literature on the use of electroconvulsive therapy (ECT) in patients with FTD to assess its effectiveness and predictors of response in this population. A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, with searches in the MEDLINE, Scopus, and Web of Science databases. Eligibility criteria included original studies and case reports on FTD patients treated with ECT. Of 88 screened abstracts, 25 studies were included, documenting 37 patients with FTD or Pick disease who were treated with ECT. ECT was primarily administered for catatonia (37.84%) and depressive episodes (35.14%). Most patients had not responded to at least 1 prior medication, primarily antipsychotics. Following the initial ECT course, 40.54% of patients experienced symptom remission, 21.62% showed partial or transient improvement, and 32.43% saw little to no benefit. Continuation and maintenance ECT appeared to be valid treatment options following a response to acute ECT. Notably, patients with the C9orf72 mutation showed a poor response to ECT. For many FTD patients with behavioral, mood, and catatonic symptoms, ECT appears to be more effective than pharmacological treatments; however, its impact on cognition and long-term outcomes requires further investigation. Systematic clinical studies on larger samples are necessary to confirm the efficacy and tolerability of ECT for psychiatric disorders in FTD.