Magnetic seizure therapy and other convulsive therapies
Electroconvulsive therapy (ECT) remains an important treatment for severely depressed patients, but its use is limited by its cognitive side effects. Magnetic seizure therapy (MST) is currently being developed as a means to lower the side effects of ECT through enhanced control over the site of stimulation and seizure initiation. MST involves the induction of a seizure under general anesthesia using high-frequency repetitive transcranial magnetic stimulation. Recent research suggests that strategies to focus current and seizure initiation in prefrontal cortex may enhance efficacy. Likewise, limiting current and seizure spread in medial temporal lobes might be expected to reduce side effects. However, the application of an electrical stimulus across the scalp and skull results in significant shunting and offers little control over current spread. Since magnetic fields pass through tissue without impedance, MST offers the promise of more precise control over induced electrical current and seizure initiation. This article reviews the current status of MST, from device development, to preclinical testing, to clinical trials. Preliminary results indicate that seizures induced with MST have a better acute side-effect profile than those induced with ECT. Other approaches to optimize ECT and achieve focal seizure induction are presented and discussed.
Stanford, AD; Husain, MM; Luber, BM; Berman, R; Truesdale, MD; McClintock, S; Lisanby, SH
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