Quick recovery of orientation after magnetic seizure therapy for major depressive disorder

Abstract

Introduction Magnetic seizure therapy (MST), in which seizures are elicited with a high-frequency magnetic field, is under development as a new treatment for major depressive disorder. Its use may be justified if it produces the antidepressant effects of ECT, coupled with limited cognitive side effects. This pilot study reports shortened recovery times after MST compared with ECT as a preliminary step to evaluate the usefulness of a new 100Hz MST device. Methods We induced seizures with 100Hz magnetic transcranial stimulation in eleven patients with major depressive disorder during one session of a regular course of ECT. Recovery times after these MST and ECT induced seizures were compared. Results Seizures could be elicited in ten of the eleven patients. Stimulation over the vertex produced tonic-clonic activity on nine out of eleven occasions. Stimulation over the prefrontal midpoint elicited seizures on three out of seven occasions. The mean duration of magnetically induced seizures was 31.3 sec, ranging from 10-86 sec. All patients had an exceptionally quick recovery of orientation: mean of 7 min 12 sec (SD = 2 min 7 sec, range 4 min 20 sec – 9 min 41 sec). The recovery times were on average 15 min 35 sec shorter with MST than with ECT in the same patients (paired-samples t-test: p = 0.00009). Patients reported feeling less confused after MST. Side effects were confined to myoclonic movements, associated with the use of etomidate. Conclusions The new 100 Hz magnetic stimulator elicits seizures in the majority of patients when administered over the vertex. MST was associated with shorter recovery times and less confusion following treatment. Subsequent work will be required to assess the safety and effectiveness of MST in the treatment of depression.

Individualized Low-Amplitude Seizure Therapy: Minimizing Current for Electroconvulsive Therapy and Magnetic Seizure Therapy

“…In addition to faster reorientation, Lisanby et al (2003a) found significantly superior acute cognitive performance after MST than ECT. Faster reorientation after MST compared with prior ECT treatments was reported as well (Kirov et al, 2008). Finally, Fitzgerald et al (2013) found no evidence of neurocognitive impairment with MST.…”

An overview on clinical aspects in magnetic seizure therapy

“…Kirov et al confirmed these differences after stimulation at 100 Hz. EEG characteristics during ECT were markedly different from the EEG recorded after MST (Kirov et al 2008). In 2013, Fitzgerald et al reported shorter motor seizures, a lesser amplitude in the ictal activity and much less postictal suppression.…”

“…After the development of high-dose MST (HD-MST) with higher frequencies at 100 Hz, Kirov and colleagues published the first report on shorter reorientation time after An overview on clinical aspects in magnetic seizure therapy MST compared to ECT and less postictal confusion (Kirov et al 2008). Some more studies have suggested a favorable cognitive side effects profile of MST compared to ECT.…”

The Use of ECT and MST in treating depression

“…Though studies in humans are based on individual case reports or small (less than 20 participants) groups there is growing evidence that MST is associated with few subjective and objective cognitive side effects (Hoy & Fitzgerald, 2010b;Kayser et al, 2011;Kosel et al, 2003;Lisanby et al, 2003a;Lisanby et al, 2001b), as well as rapid recovery of orientation after treatment compared with ECT (Kirov et al, 2008;White et al, 2006). Though more studies are needed, the neuropsychological profi le is likely to be superior to ECT.…”

“…Early development of MST identifi ed potential adverse effects and associated solutions: earplug were used to protect hearing (rTMS produces a loud clicking caused by the vibrating of the copper wires within the stimulating coil) and electroencephalographic electrodes were modifi ed (using MRI compatible EEG electrodes) to prevent heating and potential for scalp burns (Lisanby, 2002). Use of 100 Hz transcranial magnetic stimulation over the vertex, closest to the motor cortex, appears to be the most reliable method of seizure induction (seizures induced in 10 out of 11 patients in one study) (Kirov et al, 2008) and is now the most frequently used stimulation (Kayser et al, 2011).…”