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

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish (US)
Article number310
JournalFrontiers in Psychiatry
Volume8
Issue numberJAN
DOIs
StatePublished - Jan 16 2018

Fingerprint

Schizophrenia
Seizures
Brief Psychiatric Rating Scale
Therapeutics
Episodic Memory
Quality of Life
Equipment and Supplies
Electroconvulsive Therapy
Transcranial Magnetic Stimulation
Neuropsychological Tests
Quality Improvement
Clinical Trials
Depression

Keywords

  • Brain stimulation
  • Cognition
  • Electroconvulsive therapy
  • Magnetic seizure therapy
  • Neuromodulation
  • Schizoaffective disorder
  • Schizophrenia

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Tang, V. M., Blumberger, D. M., McClintock, S. M., Kaster, T. S., Rajji, T. K., Downar, J., ... Daskalakis, Z. J. (2018). Magnetic seizure therapy in treatment-resistant schizophrenia: A pilot study. Frontiers in Psychiatry, 8(JAN), [310]. https://doi.org/10.3389/fpsyt.2017.00310

Magnetic seizure therapy in treatment-resistant schizophrenia : A pilot study. / Tang, Victor M.; Blumberger, Daniel M.; McClintock, Shawn M.; Kaster, Tyler S.; Rajji, Tarek K.; Downar, Jonathan; Fitzgerald, Paul B.; Daskalakis, Zafiris J.

In: Frontiers in Psychiatry, Vol. 8, No. JAN, 310, 16.01.2018.

Research output: Contribution to journalArticle

Tang, VM, Blumberger, DM, McClintock, SM, Kaster, TS, Rajji, TK, Downar, J, Fitzgerald, PB & Daskalakis, ZJ 2018, 'Magnetic seizure therapy in treatment-resistant schizophrenia: A pilot study', Frontiers in Psychiatry, vol. 8, no. JAN, 310. https://doi.org/10.3389/fpsyt.2017.00310
Tang, Victor M. ; Blumberger, Daniel M. ; McClintock, Shawn M. ; Kaster, Tyler S. ; Rajji, Tarek K. ; Downar, Jonathan ; Fitzgerald, Paul B. ; Daskalakis, Zafiris J. / Magnetic seizure therapy in treatment-resistant schizophrenia : A pilot study. In: Frontiers in Psychiatry. 2018 ; Vol. 8, No. JAN.
@article{7d76aa5b4ed747b1ac1f93cd13ba6fa8,
title = "Magnetic seizure therapy in treatment-resistant schizophrenia: A pilot study",
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.",
keywords = "Brain stimulation, Cognition, Electroconvulsive therapy, Magnetic seizure therapy, Neuromodulation, Schizoaffective disorder, Schizophrenia",
author = "Tang, {Victor M.} and Blumberger, {Daniel M.} and McClintock, {Shawn M.} and Kaster, {Tyler S.} and Rajji, {Tarek K.} and Jonathan Downar and Fitzgerald, {Paul B.} and Daskalakis, {Zafiris J.}",
year = "2018",
month = "1",
day = "16",
doi = "10.3389/fpsyt.2017.00310",
language = "English (US)",
volume = "8",
journal = "Frontiers in Psychiatry",
issn = "1664-0640",
publisher = "Frontiers Research Foundation",
number = "JAN",

}

TY - JOUR

T1 - Magnetic seizure therapy in treatment-resistant schizophrenia

T2 - A pilot study

AU - Tang, Victor M.

AU - Blumberger, Daniel M.

AU - McClintock, Shawn M.

AU - Kaster, Tyler S.

AU - Rajji, Tarek K.

AU - Downar, Jonathan

AU - Fitzgerald, Paul B.

AU - Daskalakis, Zafiris J.

PY - 2018/1/16

Y1 - 2018/1/16

N2 - 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.

AB - 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.

KW - Brain stimulation

KW - Cognition

KW - Electroconvulsive therapy

KW - Magnetic seizure therapy

KW - Neuromodulation

KW - Schizoaffective disorder

KW - Schizophrenia

UR - http://www.scopus.com/inward/record.url?scp=85040818142&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85040818142&partnerID=8YFLogxK

U2 - 10.3389/fpsyt.2017.00310

DO - 10.3389/fpsyt.2017.00310

M3 - Article

VL - 8

JO - Frontiers in Psychiatry

JF - Frontiers in Psychiatry

SN - 1664-0640

IS - JAN

M1 - 310

ER -