A pilot study of the comparative efficacy of 100Hz magnetic seizure therapy and electroconvulsive therapy in persistent depression
A pilot study of the comparative efficacy of 100Hz magnetic seizure therapy and electroconvulsive therapy in persistent depression
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DOI：
10.1002/da.22715
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发表时间：
2018-05-01
影响因子：
7.4
通讯作者：
Daskalakis, Zafiris J.
中科院分区：
文献类型：
--
作者：
Fitzgerald, Paul B.;Hoy, Kate E.;Daskalakis, Zafiris J.
背景：磁癫痫疗法(MST)是一种利用高功率经颅磁刺激装置产生治疗性癫痫发作的新型脑刺激技术。初步的MST研究发现，在没有认知副作用的情况下，有抗抑郁作用，但与电惊厥治疗(ECT)相比，其疗效尚不清楚。本研究的目的是比较MST与标准右侧ECT治疗的疗效和认知特征。方法：37例患者采用随机双盲方案完成至少9个ECT或MST治疗的疗程。治疗前后进行抑郁严重程度和认知评估。结果：尽管两组的总体应答率都很低，但在任何临床结果指标上，两种治疗方法之间的抗抑郁有效性没有差异。在认知方面，在MST之后，精神运动速度、言语记忆和认知抑制的测试有了显著的改善，认知能力没有下降。在ECT后，只有一项认知抑制任务有了显著的改善。在组间比较方面，MST组在精神运动速度方面的改善明显高于ECT。结论：MST对无认知副作用的难治性抑郁症患者的疗效与右侧ECT相似，但样本大小仅足以证明两组之间的反应存在较大差异。未来的研究应该着眼于优化MST的给药方法，并在大型随机对照试验中将其疗效与ECT进行比较。
Background: Magnetic seizure therapy (MST) is a novel brain stimulation technique that uses a high-powered transcranial magnetic stimulation device to produce therapeutic seizures. Preliminary MST studies have found antidepressant effects in the absence of cognitive side effects but its efficacy compared to electroconvulsive therapy (ECT) remains unclear. The aim of this study was to investigate the therapeutic efficacy and cognitive profile of MST compared to standard right unilateral ECT treatment.Methods: Thirty-seven patients completed a course of at least nine ECT or MST treatments in a randomized double-blind protocol. Assessments of depression severity and cognition were performed before and after treatment.Results: No difference in the antidepressant effectiveness between the treatments was seen across any of the clinical outcome measures, although the overall response rates in both groups were quite low. In regards to cognition, following MST there were significant improvements in tests of psychomotor speed, verbal memory, and cognitive inhibition, with no reductions in cognitive performance. Following ECT there was significant improvement in only one of the cognitive inhibition tasks. With respect to the between-group comparisons, the MST group showed a significantly greater improvement on psychomotor speed than ECT.Conclusions: MST showed similar efficacy to right unilateral ECT in patients with treatment-resistant depression without cognitive side effects but in a sample that was only of sufficient size to demonstrate relatively large differences in response between the two groups. Future research should aim to optimize the methods of MST administration and compare its efficacy to ECT in large randomized controlled trials.