Magnetic Seizure Therapy Compared to Electroconvulsive Therapy for Schizophrenia: A Randomized Controlled Trial

Jiangling Jiang; Jin Li; Yuanhong Xu; Bin Zhang; Jianhua Sheng; Dengtang Liu; Wenzheng Wang; Fuzhong Yang; Xiaoyun Guo; Qingwei Li; Tianhong Zhang; Yingying Tang; Yuping Jia; Zafiris J Daskalakis; Jijun Wang; Chunbo Li

doi:10.3389/fpsyt.2021.770647

Magnetic Seizure Therapy Compared to Electroconvulsive Therapy for Schizophrenia: A Randomized Controlled Trial

Front Psychiatry. 2021 Nov 25:12:770647. doi: 10.3389/fpsyt.2021.770647. eCollection 2021.

Authors

Jiangling Jiang¹, Jin Li¹, Yuanhong Xu¹, Bin Zhang², Jianhua Sheng¹, Dengtang Liu¹, Wenzheng Wang¹, Fuzhong Yang¹, Xiaoyun Guo¹, Qingwei Li³, Tianhong Zhang¹, Yingying Tang¹, Yuping Jia¹, Zafiris J Daskalakis⁴, Jijun Wang^{1

5

6

7}, Chunbo Li^{1

5

6

7}

Affiliations

¹ Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Psychological and Psychiatric Neuroimage Lab, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
³ Department of Psychiatry, Tongji Hospital of Tongji University, Shanghai, China.
⁴ Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.
⁵ Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China.
⁶ Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China.
⁷ Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.

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.

Keywords: cognitive functions; electroconvulsive therapy; magnetic seizure therapy; randomized controlled trial; schizophrenia.

Associated data

ClinicalTrials.gov/NCT02746965