Magnetic Seizure Therapy in Treatment-Resistant Schizophrenia: A Pilot Study

Victor M Tang, Daniel M Blumberger, Shawn M McClintock, Tyler S Kaster, Tarek K Rajji, Jonathan Downar, Paul B Fitzgerald, Zafiris J Daskalakis, Victor M Tang, Daniel M Blumberger, Shawn M McClintock, Tyler S Kaster, Tarek K Rajji, Jonathan Downar, Paul B Fitzgerald, Zafiris J Daskalakis

Abstract

Objective: Electroconvulsive therapy is effective in treatment-resistant schizophrenia (TRS) but use is limited due to stigma and concerns around cognitive adverse effects. Magnetic seizure therapy (MST) is a promising new neuromodulation technique that uses transcranial magnetic stimulation to induce therapeutic seizures. Studies of MST in depression have shown clinical improvement with a favorable adverse effect profile. No studies have examined the clinical utility of MST in schizophrenia.

Methods: We conducted an open-label pilot clinical trial of MST in eight TRS patients. Up to 24 MST treatments were delivered depending on treatment response. We assessed clinical outcome through the Brief Psychiatric Rating Scale (BPRS) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Cognitive testing included a neuropsychological test battery, the Autobiographical Memory Inventory (AMI), Montreal Cognitive Assessment (MoCA), and reorientation time.

Results: Four patients completed the trial as per protocol. For all patients and for trial completers alone, there was a significant clinical and quality of life improvement. Three met pre-determined criteria for remission (total score ≤25 on the BPRS) and one met criteria for response (i.e., ≥25% BPRS improvement from baseline for two consecutive assessments). Pre and post neurocognitive data showed no significant cognitive adverse effects apart from a decrease in AMI scores.

Conclusion: In this pilot study, MST demonstrated evidence for feasibility in patients with TRS, with promise for clinical efficacy and negligible cognitive side effects. Further study in larger clinical populations is needed.

Clinical trial registration: www.ClinicalTrials.gov, Identifier NCT01596608.

Keywords: brain stimulation; cognition; electroconvulsive therapy; magnetic seizure therapy; neuromodulation; schizoaffective disorder; schizophrenia.

Figures

Figure 1
Figure 1
Flow diagram for individual patients enrolled in the study. SCZ, schizophrenia; SCZ-A, schizoaffective. QoL, quality of life as measured by the Quality of Life Enjoyment and Satisfaction Questionnaire; Hz, frequency of stimulation; Tx, number of magnetic seizure therapy treatment sessions completed.

References

    1. McGrath J, Saha S, Chant D, Welham J. Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev (2008) 30(1):67–76.10.1093/epirev/mxn001
    1. Pantelis C, Lambert TJ. Managing patients with “treatment-resistant” schizophrenia. Med J Aust (2003) 178(9):S62.
    1. Suzuki T, Remington G, Mulsant BH, Uchida H, Rajji TK, Graff-Guerrero A, et al. Defining treatment-resistant schizophrenia and response to antipsychotics: a review and recommendation. Psychiatry Res (2012) 197(1):1–6.10.1016/j.psychres.2012.02.013
    1. Miller DD. Review and management of clozapine side effects. J Clin Psychiatry (2000) 61:14–7.
    1. Agid O, Arenovich T, Sajeev G, Zipursky RB, Kapur S, Foussias G, et al. An algorithm-based approach to first-episode schizophrenia: response rates over 3 prospective antipsychotic trials with a retrospective data analysis. J Clin Psychiatry (2011) 72(11):1439–44.10.4088/JCP.09m05785yel
    1. Kaster TS, Daskalakis ZJ, Blumberger DM. Clinical effectiveness and cognitive impact of electroconvulsive therapy for schizophrenia: a large retrospective study. J Clin Psychiatry (2017) 78(4):e383.10.4088/JCP.16m10686
    1. Tharyan P, Adams CE. Electroconvulsive therapy for schizophrenia. Cochrane Database Syst Rev (2005) 2:CD000076.10.1002/14651858.CD000076.pub2
    1. Pompili M, Lester D, Dominici G, Longo L, Marconi G, Forte A, et al. Indications for electroconvulsive treatment in schizophrenia: a systematic review. Schizophr Res (2013) 146(1):1–9.10.1016/j.schres.2013.02.005
    1. Petrides G, Malur C, Braga RJ, Bailine SH, Schooler NR, Malhotra AK, et al. Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study. Am J Psychiatry (2014) 172(1):52–8.10.1176/appi.ajp.2014.13060787
    1. Semkovska M, McLoughlin DM. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry (2010) 68(6):568–77.10.1016/j.biopsych.2010.06.009
    1. Fraser LM, O’Carroll RE, Ebmeier KP. The effect of electroconvulsive therapy on autobiographical memory: a systematic review. J ECT (2008) 24(1):10–7.10.1097/YCT.0b013e3181616c26
    1. Lisanby SH. Electroconvulsive therapy for depression. N Engl J Med (2007) 357(19):1939–45.10.1056/NEJMct075234
    1. Dowman J, Patel A, Rajput K. Electroconvulsive therapy: attitudes and misconceptions. J ECT (2005) 21(2):84–7.10.1097/01.yct.0000161043.00911.45
    1. Lisanby SH, Luber B, Schlaepfer TE, Sackeim HA. Safety and feasibility of magnetic seizure therapy (MST) in major depression: randomized within-subject comparison with electroconvulsive therapy. Neuropsychopharmacology (2003) 28(10):1852.10.1038/sj.npp.1300229
    1. Sun Y, Farzan F, Mulsant BH, Rajji TK, Fitzgerald PB, Barr MS, et al. Indicators for remission of suicidal ideation following magnetic seizure therapy in patients with treatment-resistant depression. JAMA Psychiatry (2016) 73(4):337–45.10.1001/jamapsychiatry.2015.3097
    1. McClintock SM, Tirmizi O, Chansard M, Husain MM. A systematic review of the neurocognitive effects of magnetic seizure therapy. Int Rev Psychiatry (2011) 23(5):413–23.10.3109/09540261.2011.623687
    1. Deng ZD, Lisanby SH, Peterchev AV. Electric field strength and focality in electroconvulsive therapy and magnetic seizure therapy: a finite element simulation study. J Neural Eng (2011) 8(1):016007.10.1088/1741-2560/8/1/016007
    1. Kirov G, Ebmeier KP, Scott AI, Atkins M, Khalid N, Carrick L, et al. Quick recovery of orientation after magnetic seizure therapy for major depressive disorder. Br J Psychiatry (2008) 193(2):152–5.10.1192/bjp.bp.107.044362
    1. Polster JD, Kayser S, Bewernick BH, Hurlemann R, Schlaepfer TE. Effects of electroconvulsive therapy and magnetic seizure therapy on acute memory retrieval. J ECT (2015) 31(1):13–9.10.1097/YCT.0000000000000130
    1. Kayser S, Bewernick BH, Grubert C, Hadrysiewicz BL, Axmacher N, Schlaepfer TE. Antidepressant effects, of magnetic seizure therapy and electroconvulsive therapy, in treatment-resistant depression. J Psychiatr Res (2011) 45(5):569–76.10.1016/j.jpsychires.2010.09.008
    1. Fitzgerald PB, Hoy KE, Herring SE, Clinton AM, Downey G, Daskalakis ZJ. Pilot study of the clinical and cognitive effects of high-frequency magnetic seizure therapy in major depressive disorder. Depress Anxiety (2013) 30(2):129–36.10.1002/da.22005
    1. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute; (2002).
    1. Overall JE, Gorham DR. The brief psychiatric rating scale. Psychol Rep (1962) 10(3):799–812.10.2466/pr0.1962.10.3.799
    1. Andreescu C, Mulsant BH, Peasley-Miklus C, Rothschild AJ, Flint AJ, Heo M, et al. Persisting low use of antipsychotics in the treatment of major depressive disorder with psychotic features. J Clin Psychiatry (2007) 68(2):194–200.10.4088/JCP.v68n0203
    1. Endicott J, Nee J, Harrison W, Blumenthal R. Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure. Psychopharmacol Bull (1993) 29:321–6.
    1. King MJ, MacDougall AG, Ferris SM, Levine B, MacQueen GM, McKinnon MC. A review of factors that moderate autobiographical memory performance in patients with major depressive disorder. J Clin Exp Neuropsychol (2010) 32(10):1122–44.10.1080/13803391003781874
    1. Nuechterlein KH, Green MF. MATRICS Consensus Cognitive Battery Manual. Los Angeles, CA: MATRICS Assessment Inc. (2006).
    1. Partington JE, Leiter RG. Partington’s pathways test. Psychological Serv Center Bull (1949) 1:9–20.
    1. Golden C. The Stroop Color and Word Test. Chicago, IL: Stoelting Company; (1978).
    1. Spreen O, Strauss EA. Compendium of Neuropsychological Tests. 2nd ed New York: Oxford University Press; (1998).
    1. Wechsler D. Manual for the Wechsler Memory Scale-Revised. San Antonio: The Psychological Corporation; (1987).
    1. Leucht S, Kane JM, Kissling W, Hamann J, Eetschel EVA, Engel R. Clinical implications of brief psychiatric rating scale scores. Br J Psychiatry (2005) 187:366–71.10.1192/bjp.187.4.366
    1. Zheng W, Cao XL, Ungvari GS, Xiang YQ, Guo T, Liu ZR, et al. Electroconvulsive therapy added to non-clozapine antipsychotic medication for treatment resistant schizophrenia: meta-analysis of randomized controlled trials. PLoS One (2016) 11(6):e0156510.10.1371/journal.pone.0156510
    1. Lally J, Tully J, Robertson D, Stubbs B, Gaughran F, MacCabe JH. Augmentation of clozapine with electroconvulsive therapy in treatment resistant schizophrenia: a systematic review and meta-analysis. Schizophr Res (2016) 171(1):215–24.10.1016/j.schres.2016.01.024
    1. Semkovska M, McLoughlin DM. Measuring retrograde autobiographical amnesia following electroconvulsive therapy: historical perspective and current issues. J ECT (2013) 29(2):127–33.10.1097/YCT.0b013e318279c2c9
    1. Semkovska M, McLoughlin DM. Retrograde autobiographical amnesia after electroconvulsive therapy: on the difficulty of finding the baby and clearing murky bathwater. J ECT (2014) 30(3):187–8.10.1097/YCT.0000000000000122
    1. Chanpattana W, Chakrabhand MS, Sackeim HA, Kitaroonchai W, Kongsakon R, Techakasem P, et al. Continuation ECT in treatment-resistant schizophrenia: a controlled study. J ECT (1999) 15(3):178–92.10.1097/00124509-199909000-00002
    1. Kho KH, Blansjaar BA, De Vries S, Babuskova D, Zwinderman AH, Linszen DH. Electroconvulsive therapy for the treatment of clozapine nonresponders suffering from schizophrenia. Eur Arch Psychiatry Clin Neurosci (2004) 254(6):372–9.10.1007/s00406-004-0517-y
    1. White PF, Amos Q, Zhang Y, Stool L, Husain MM, Thornton L, et al. Anesthetic considerations for magnetic seizure therapy: a novel therapy for severe depression. Anesth Analg (2006) 103(1):76–80.10.1213/01.ane.0000221182.71648.a3

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