Magnetic seizure therapy: development of a novel intervention for treatment resistant depression
摘要
Electroconvulsive therapy (ECT) is the most effective and most rapidly acting treatment for severe treatment resistant major depression, but its use is limited by its cognitive side effects. Magnetic seizure therapy (MST) is a new form of convulsive therapy using high-dosage repetitive transcranial magnetic stimulation (rTMS) to induce focal cortical seizures under anesthesia. MST is under study as a means of reducing the side effects of ECT through the enhanced control over the sites of seizure initiation and topography of seizure propagation afforded by the relative focality of rTMS. This review traces the stages in the development of MST, from device development, to preclinical testing, to clinical trials. The results of a study on the comparative safety of chronic MST and electroconvulsive shock in non-human primates support the safety of both interventions, and indicate that the seizures induced by MST are more focal and have less impact on deeper brain structures. This non-human primate model and a controlled clinical trial in patients with major depression, suggest that MST may induce fewer side effects and less amnesia than ECT. Ongoing work will yield the first data on the antidepressant efficacy of MST. If ultimately shown to be effective, MST could represent a new, less invasive option for patients with severe treatment resistant depression or other disorders who would otherwise require ECT.