Magnetic Seizure Therapy Compared to Electroconvulsive Therapy for Schizophrenia: A Randomized Controlled Trial

Abstract

Background: Magnetic seizure therapy (MST) is a potential alternative to electroconvulsive therapy (ECT). However, reports on the use of MST for patients with schizophrenia, particularly in developing countries, which is a main indication for ECT, are limited.Methods: From February 2017 to July 2018, 79 inpatients who met the DSM-5 criteria for schizophrenia were randomized to receive 10 sessions of MST (43 inpatients) or ECT (36 inpatients) over the course of 4 weeks. At baseline and 4-week follow-up, the Positive and Negative Syndrome Scale (PANSS) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were used to assess symptom severity and cognitive functions, respectively.Results: Seventy-one patients who completed at least half of the treatment protocol were included in the per-protocol analysis. MST generated a non-significant larger antipsychotic effect in terms of a reduction in PANSS total score [g = 0.17, 95% confidence interval (CI) = −0.30, 0.63] and response rate [relative risk (RR) = 1.41, 95% CI = 0.83–2.39]. Twenty-four participants failed to complete the cognitive assessment as a result of severe psychotic symptoms. MST showed significant less cognitive impairment over ECT in terms of immediate memory (g = 1.26, 95% CI = 0.63–1.89), language function (g =1.14, 95% CI = 0.52–1.76), delayed memory (g = 0.75, 95% CI = 0.16–1.35), and global cognitive function (g = 1.07, 95% CI = 0.45–1.68). The intention-to-treat analysis generated similar results except for the differences in delayed memory became statistically insignificant. Better baseline cognitive performance predicted MST and ECT response.Conclusions: Compared to bitemporal ECT with brief pulses and age-dose method, MST had similar antipsychotic efficacy with fewer cognitive impairments, indicating that MST is a promising alternative to ECT as an add-on treatment for schizophrenia.Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT02746965.

Magnetic Seizure Therapy vs Modified Electroconvulsive Therapy in Patients With Bipolar Mania

“…The different effects on language function between MST and ECT are consistent with previous studies regarding MDD and schizophrenia . Wang et al reported some language improvement after accelerated MST in patients with MDD.…”

“…Previous studies suggested that high-frequency MST (100 Hz) could lead to a better remission rate than low-frequency (25 Hz) and medium-frequency (50 or 60 Hz) MST but a lower reduction of suicidality . The target symptoms and population may affect the association of MST frequency and efficacy, which remains unclear. The electric field induced by ECT parameters has been attributed to antidepressant or cognitive outcomes and brain neuroplasticity .…”

“…Magnetic seizure therapy has a robust antidepressant effect, which is indistinguishable from that of ECT as reported by a recent randomized clinical trial (RCT) . Magnetic seizure therapy may also improve psychotic symptoms in patients with schizophrenia . Preliminary evidence has shown that patients receiving MST may have shorter recovery and reorientation times and less cognitive impairment than those receiving ECT .…”

Comparison of Efficacy and Safety of Magnetic Seizure Therapy and Electroconvulsive Therapy for Depression: A Systematic Review

“…Interestingly, the response rate of ECT for subjects diagnosed with schizophrenia was up to 74% [ 51 ], which was relatively higher than the response rate for MST of 37.5% to 50% [ 23 , 52 ]. However, another RCT found that MST had antipsychotic efficacy similar to that of ECT [ 53 ]. In recent years, MST has appeared to be an essential and interesting treatment option in depression and schizophrenia.…”

A Systematic Review of Intermittent Theta Burst Stimulation for Neurocognitive Dysfunction in Older Adults with Schizophrenia

“…Similarly, a recent systematic review reported inconsistent findings on the neurocognitive effects of MST in schizophrenia [ 37 ]. For example, Jiang et al found that MST showed significantly less cognitive impairment with regard to immediate memory, language function, delayed memory and global cognitive function when compared to ECT [ 38 ]. Another study reported that MST led to a specific deficit in the Autobiographical Memory Inventory-Short Form (AMI-SF) without affecting other cognitive domains [ 39 ].…”