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.
Highlights
Schizophrenia is generally characterized by marked dysfunction in cognition, behavior, and emotion
Six subjects were excluded from the final analysis for the following reasons: one patient in the Magnetic seizure therapy (MST) group withdrew prior to the first treatment due to financial difficulty; another patient withdrew due to financial difficulty after the second session; one patient withdrew because a tumor was found in his brain after the fifth session; one patient withdrew after the first session due to hypotension (80/50 mmHg); one patient in the MST group, who felt that his symptoms did not improve after three sessions of treatment, predicted that his allocation was MST, and requested withdrawal from the study to receive Electroconvulsive therapy (ECT); one patient withdrew due to wearing of the MST coils after the second session
The results of the present study suggest that MST is a promising alternative treatment to ECT for the treatment of schizophrenia, with a comparable antipsychotic effect and less cognitive impairments to that of bitemporal ECT with brief pulses and age-dose method in short term
Summary
Schizophrenia is generally characterized by marked dysfunction in cognition, behavior, and emotion. While antipsychotics are the mainstay treatment for schizophrenia, ∼30% of patients do not respond fully to pharmacotherapy [4]. Electroconvulsive therapy (ECT) is an important treatment option when the response to pharmacotherapy alone is unsatisfactory, or when rapid improvement in global functioning and psychotic symptoms is desired [5]. Cognitive side effects, such as amnesia, headache, and disorientation, are common [7]. The substantial impedance of the scalp and skull leads to widespread electrical stimulation through the whole brain, which is thought to underlie the cognitive side effects of ECT [8]. Reports on the use of MST for patients with schizophrenia, in developing countries, which is a main indication for ECT, are limited
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