top of page

Child Psychiatrist /Adult Psychiatrist

First Trial Results of Magnetic Seizure Therapy vs ECT for Bipolar Mania

Magnetic seizure therapy (MST) offers similar efficacy as electroconvulsive therapy (ECT) in treating bipolar mania in adults, with significantly fewer adverse effects on language abilities, new research suggests.

Bipolar Mania

The randomized clinical trial is the first to study the efficacy of MST for acute manic symptoms. Investigators found that most participants had good response rates with both therapies, but those in the MST group showed superior preservation of language abilities than those in the ECT group.

"These findings suggest that MST is associated with a high response rate and fewer cognitive impairments in bipolar mania, and that it might be an alternative therapy for the treatment of bipolar mania," lead investigator Shan Chen, MMed, of the Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China, and colleagues wrote.

The study was published online on April 29 in JAMA Network Open.

First MST Trial

Pharmacotherapy is regarded as first-line treatment for bipolar mania, with ECT as a second-line option for patients with inadequate response to first-line monotherapy, the authors wrote.

However, the use of ECT to treat bipolar mania is limited by several adverse effects, including cognitive impairment and stigma.

Previous research showed that MST is associated with symptom improvement in patients with treatment-resistant depression and schizophrenia, but its efficacy for acute bipolar mania had not been studied.

The therapy uses magnetic pulses, rather than electrical currents, while patients are under general anesthesia. Magnetic pulses are not impeded by the skull and thus can be targeted over the cortical region to minimize or possibly prevent adverse cognitive effects.

For the trial, 48 patients with bipolar mania received either ECT (mean age, 32 years; 60% men) or MST (mean age, 35 years; 68% men). Participants completed two or three sessions of the interventions per week for a total of eight to 10 sessions.

Mania symptoms were measured with the Young Mania rating Scale (YMRS), administered before and after MST and ECT, with a reduction in the total score as the primary outcome. A response to treatment was defined as > 50% reduction in the total YMRS score from baseline.

Patients' depressive symptoms were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS), and neurocognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status.

Age, sex, years of education, marital status, YMRS, and MADRS scores at baseline did not differ between the two groups.

Language Preserved With MST

At baseline, the daily chlorpromazine-equivalent doses of atypical antipsychotics were significantly higher in the MST group (P = .02). But after treatment, the daily doses were comparable between the groups (P = .86), and the increase in daily doses was significantly greater in the ECT group (P = .02).

Both groups had a high response rate to treatment, with no significant differences between the two (95% with ECT vs 86% with MST; P = .67). There was also no significant difference between groups in reduction of mania symptoms or in neurocognitive function.

Patients receiving ECT had worse language performance after treatment compared to baseline (P = .045), while people in the MST group had no significant changes. These findings are similar to those found in previous studies in major depressive disorder and schizophrenia, investigators noted.

Patients in the MST group had shorter seizures (mean duration, 10 seconds vs 37 seconds, respectively), and neither group reported any serious adverse effects.

Limitations included the lack of precise sample size estimation for a noninferiority design and a small sample size. Moreover, the researchers did not restrict the use of concomitant psychotropic medication during either intervention, and the daily chlorpromazine-equivalent doses were initially higher in the MST vs the ECT group, so the effects of medication on the outcomes cannot be excluded.

More Study Needed

In an accompanying editorial, Axel Nordenskjöld, MD, PhD, of the Universitetssjukhuset Örebro, Örebro, Sweden, and coauthors noted that ECT involves a "trade-off, where more intensive stimuli result in more intense seizures, stronger clinical effects, and more cognitive adverse effects."

However, he added the trade-off may be necessary because stronger clinical effects are usually the goal in the treatment of severe mania.

"Magnetic seizure therapy has been introduced as a more tolerable form of convulsive therapy. It has been claimed that the cognitive adverse effects may be reduced compared with standard ECT, while the clinical effects are similar," the authors wrote. "If this is true, MST may be an improvement over ECT. However, so far, there are not enough data to support the claim, and the field has been mistaken before."

While these and other findings on MST suggest the therapy could be an alternative for ECT, "it is important to stress that the evidence on the effectiveness and safety profile of MST is still limited," the authors wrote.

The small number of participants and the shorter seizure duration with MST are two issues that would need to be addressed in future trials, they added.

"If it becomes less complicated to produce adequate seizures using MST in the future, it may come to be regarded as an alternative and equivalent form of convulsive therapy to ECT," the commentary authors wrote. "Then, we can worry less about whether the electromagnetic field is produced by electrodes or coils and put more emphasis on the quality of the seizure."

This work was supported by grants from STI2030-Major Projects, the Science and Technology Commission of Shanghai Municipality, the National Natural Science Foundation of China, the Clinical Research Center at Shanghai Mental Health Center, the Shanghai Clinical Research Center for Mental Health, the Shanghai Talented Youth Program, and the Shanghai Municipal Education Commission-Gaofeng Clinical Medicine. The study authors and Nordenskjöld reported no relevant financial relationships. The other editorial coauthors' disclosures are listed on the original paper.

Note: This article originally appeared on Medscape

0 views0 comments


bottom of page