Adjunctive Magnetic Seizure Therapy for Schizophrenia: A Systematic Review

Xin-Yang Zhang,Wei Zheng,Xiong Huang,Dong-Bin Cai,Huo-Di Chen,Wan-Nian Liang,Xin-Hu Yang,Xing-Bing Huang,Cheng-Yi Liu

doi:10.3389/fpsyt.2021.813590

Abstract

Objective: The efficacy and safety of adjunctive magnetic seizure therapy (MST) for patients with schizophrenia are unclear. This systematic review was conducted to examine the efficacy and safety of adjunctive MST for schizophrenia.Methods: Chinese (WanFang and Chinese Journal Net) and English (PubMed, EMBASE, PsycINFO, and the Cochrane Library) databases were systematically searched.Results: Two open-label self-controlled studies (n = 16) were included and analyzed in this review. In these studies, the Positive and Negative Syndrome Scale (PANSS) total scores and Brief Psychiatric Rating Scale (BPRS) total scores significantly decreased from baseline to post-MST (all Ps < 0.05), without serious adverse neurocognitive effects. Mixed findings on the neurocognitive effects of adjunctive MST for schizophrenia were reported in the two studies. A discontinuation rate of treatment of up to 50% (4/8) was reported in both studies. The rate of adverse drug reactions (ADRs) was evaluated in only one study, where the most common ADRs were found to be dizziness (25%, 2/8) and subjective memory loss (12.5%, 1/8).Conclusion: There is inconsistent evidence for MST-related adverse neurocognitive effects and preliminary evidence for the alleviation of psychotic symptoms in schizophrenia.

Highlights

Schizophrenia is a severely disabling psychiatric disorder affecting ∼1% of the population worldwide [1,2,3]
Intervention vs. Comparison: treatment as usual (TAU) plus magnetic seizure therapy (MST) vs. TAU plus electroconvulsive therapy (ECT) (RCTs); MST added to TAU
Outcomes: in this systematic review, the primary outcome was the improvement of psychotic symptoms, as measured by the Positive and Negative Syndrome Scale (PANSS) [40] or Brief Psychiatric Rating Scale (BPRS) [41]

Summary

Introduction

Schizophrenia is a severely disabling psychiatric disorder affecting ∼1% of the population worldwide [1,2,3]. ECT is the most effective treatment for individuals suffering from schizophrenia [22, 23] and mood disorders [24]. A recent randomized controlled trial (RCT) [22] and meta-analysis [23] found that the augmentation of clozapine with ECT is a highly effective therapy for clozapine-resistant schizophrenia (CRS). ECT is an effective and safe method in treating elderly patients with treatment-resistant depression (TRD) [25]. ECT-related adverse neurocognitive effects, including disorientation, amnesia, and executive dysfunction, prevent the use of ECT as a firstchoice therapy for schizophrenia and mood disorders [27,28,29]. The damaging stigma surrounding ECT potentially impedes widespread acceptance of this therapy among individuals suffering from schizophrenia [30]

Methods

Results

Conclusion