Safety and Feasibility of Magnetic Seizure Therapy (MST) in Major Depression: Randomized Within-Subject Comparison with Electroconvulsive Therapy

Abstract

Magnetic seizure therapy (MST) is a novel means of performing convulsive therapy using rapidly alternating strong magnetic fields. MST offers greater control of intracerebral current intensity than is possible with electroconvulsive therapy (ECT). These features may result in a superior cognitive side effect profile for MST, while possibly retaining the efficacy of ECT. The objective of this study was to determine whether MST and ECT differ in seizure characteristics, and acute objective and subjective cognitive side effects. A total of 10 inpatients in a major depressive episode referred for ECT were enrolled in this randomized, within-subject, double-masked trial. Seizure threshold was determined with MST and ECT in the first two sessions of a course of convulsive therapy, with order randomized. The remaining two sessions consisted of suprathreshold stimulation with MST and ECT. A neuropsychological battery and side effect rating scale were administered by a masked rater before and after each session. Tonic-clonic seizures were elicited with MST in all patients. Compared to ECT, MST seizures had shorter duration, lower ictal EEG amplitude, and less postictal suppression. Patients had fewer subjective side effects and recovered orientation more quickly with MST than ECT. MST was also superior to ECT on measures of attention, retrograde amnesia, and category fluency. Magnetic seizure induction in patients with depression is feasible, and appears to have a superior acute side effect profile than ECT. Future research will be needed to establish whether MST has antidepressant efficacy.

Neurostimulation as an intervention for treatment resistant depression: From research on mechanisms towards targeted neurocognitive strategies

“…In MST, which has fewer cognitive side effects, focal seizure activity is induced by TMS (Lisanby, Luber, Schlaepfer, & Sackeim, 2003). In a small open label pilot clinical trial (N=13), 38,5 % of the depressed patients showed clinical response at the end of the study (Fitzgerald et al, 2013).…”

Neural circuitry and neuroplasticity in mood disorders: Insights for novel therapeutic targets

“…12,116 These findings support the hypothesis that it is an imbalance within these circuits, rather than any specific directional disturbance in a sin- gle region, that provides a neural substrate for mood dysregulation. Magnetic seizure therapy (MST), an experimental technique using a magnetic field to induce a seizure, is currently being investigated in the treatment of depression by Lisanby et al 117 They have reported some preliminary evidence that MST may have fewer cognitive side effects than ECT. They further hypothesize that, based on intracerebral electrode studies in nonhuman primates and the fact that magnetic fields are not impeded by skull and soft tissues as is electricity, MST (if proven effective) may represent an improvement over ECT as the seizure can be more directly targeted at affective circuits and therefore may have fewer cognitive side effects than ECT.…”

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

“…This study reported low cognitive side effects in both ECT and MST groups, with faster reorientation following MST. 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).…”

“…Furthermore, magnetic seizure therapy (MST) elicits generalized seizures with an induced electric field that is substantially less intense and more focal than conventional ECT (Deng et al, 2011(Deng et al, , 2013Lee et al, 2014). After a series of promising case reports and safety and feasibility assessments (Kayser et al, 2009;Kosel et al, 2003;Lisanby et al, 2003aLisanby et al, , 2001, the efficacy and side effects of MST were evaluated in two larger studies of 13 patients (Fitzgerald et al, 2013) and 26 patients (Kayser et al, 2015). In these studies, the response rates were 38% and 69%, and the remission rates were 15% and 46%, respectively.…”