To The Editor: Considering their experience in the management of advanced Lewy body disease (1), it was surprising that in their review of the challenging convergence of neuropsychiatric comorbidity, published in the October 2007 issue of the Journal, Daniel Weintraub, M.D., and Howard I. Hurtig, M.D., (2) omitted electroconvulsive therapy (ECT)—a treatment that can address both psychosis and movement disorder and avoid a host of medication-related side effects without coupling improvement in one realm of symptoms with exacerbation of the other. Along the lines of other potentially beneficial interventions supported by clinical experience but lacking definitive evidence from scientific trials, perhaps a note pertaining to antipsychotic response to serotonin (5-HT₃) antagonist ondansetron in such cases should be included as well (3).

1.Chou KL, Hurtig HI, Jaggi JL, Baltuch GH, Pelchat RJ, Weintraub D: Electroconvulsive therapy for depression in a Parkinson’s disease patient with bilateral subthalamic nucleus deep brain stimulators. Parkinsonism Relat Disord 2005; 11:403–4062.Weintraub D, Hurtig HI: Presentation and management of psychosis in Parkinson’s disease and dementia with Lewy bodies. Am J Psychiatry 2007; 164:1491–14983.Zoldan J, Friedberg G, Livneh M, Melamed E: Psychosis in advanced Parkinson’s disease: treatment with ondansetron, a 5-HT₃ receptor antagonist. Neurology 1995; 45:1305–1308

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