Magnetic Seizure Therapy: Towards Personalized Seizure Therapy for Major Depression.
Magnetic Seizure Therapy: Towards Personalized Seizure Therapy for Major Depression.
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DOI：
10.1016/j.pmip.2019.04.003
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发表时间：
2019-11-01
期刊：
影响因子：
--
通讯作者：
Lisanby, Sarah H
中科院分区：
文献类型：
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作者：
Kallioniemi, Elisa;McClintock, Shawn M;Lisanby, Sarah H
磁癫痫疗法(MST)是一种正在研究中的治疗严重神经精神障碍的非侵入性神经调节疗法。MST包括在类似于电惊厥治疗(ECT)的环境中，在麻醉下诱导治疗性癫痫发作。到目前为止，随机对照试验表明，MST具有与ECT相似的抗抑郁疗效，但没有显著的认知不良影响。目前正在进行大规模临床试验，以证实这些初步发现。到目前为止，只有一项研究评估了MST反应的临床预测因素，还需要更多的研究。这项研究发现，抑郁症发作次数较少且有抑郁症阳性家族史的患者对MST的反应更好。总体而言，MST集中电场传递和由此导致的癫痫发作的能力使针对特定大脑区域的靶向癫痫治疗成为可能，进一步的研究将有助于识别个性化的靶点，以最大限度地发挥临床益处。在这篇综述中，我们描述了MST的方法学以及如何针对每个患者个体化。我们还总结了MST的临床和认知影响，并提供了哪些患者可能最有可能受益的适应症。最后，我们总结了已研究的反应的神经生理学预测因子。
Magnetic seizure therapy (MST) is a noninvasive neuromodulation therapy under investigation for the treatment of severe neuropsychiatric disorders. MST involves inducing a therapeutic seizure under anesthesia in a setting similar to electroconvulsive therapy (ECT). To date, randomized controlled trials suggest that MST has similar antidepressant efficacy as ECT, but without significant cognitive adverse effects. Large scale clinical trials are currently underway to confirm these preliminary findings. So far, there has only been one study evaluating the clinical predictors of response to MST and more research is needed. This study found that patients with fewer episodes of depression and a positive family history of depression had a better response to MST. Overall, the ability of MST to focus the delivery of the electric field and the resultant seizure makes targeting seizure therapy to specific brain regions possible, and further research will be helpful in identifying personalized targets to maximize clinical benefit. In this review, we describe MST methodology and how it could be individualized to each patient. We also summarize the clinical and cognitive effects of MST and provide indications of which patients may be most likely to benefit. Finally, we summarize the studied neurophysiological predictors of response.