Prillo Jake, Zapf Lorina, Espinola Caroline W, Daskalakis Zafiris J, Blumberger Daniel M
Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada.
Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Can J Psychiatry. 2024 Dec 9:7067437241301005. doi: 10.1177/07067437241301005.
ObjectiveTo qualitatively and quantitatively synthesize the literature on the efficacy and safety of magnetic seizure therapy (MST) in psychiatric disorders.MethodsA literature search was conducted of the OVID Medline, OVID EMBASE, PsychINFO, CINAHL, Web of Science and Cochrane databases from inception to 14 January 2024, using subject headings and key words for "magnetic seizure therapy." Randomized controlled trials (RCTs), post-hoc analyses of RCTs, open-label trials, or case series investigating MST in adults with a verified psychiatric diagnosis and reporting on two possible primary outcomes (1) psychiatric symptom reduction (as measured by validated rating scale) or (2) neurocognitive outcomes (as measured by standardized testing), were included. Abstracts, individual case reports, reviews and editorials were excluded. Extracted data included: (1) basic study details; (2) study design; (3) sample size; (4) baseline demographics; (5) outcome data (including secondary outcomes of suicidal ideation and adverse events); and (6) stimulation parameters. Cochrane's risk of bias tool was applied. A quantitative analysis was conducted for the depression studies, using Hedge's g effect sizes.ResultsA total of 24 studies (n = 377) were eligible for inclusion. Seventeen studies in depression (including three RCTs), four studies in schizophrenia (including one RCT), one study in bipolar disorder, one study in obsessive-compulsive disorder and one study in borderline personality disorder were summarized. We found no significant difference in depressive symptom reduction between MST and electroconvulsive therapy (ECT) in randomized, controlled trials (g = 0.207 towards ECT, 95% confidence interval (CI) -0.132 to 0.545, = 0.232). We found a significant reduction in depressive symptoms overall with MST in the pooled RCT and open-label analysis (g = 1.749, CI 1.219 to 2.279, < 0.005). It is suggested that MST has modest cognitive side effects.ConclusionsLarge-scale RCTs are necessary to confirm early signals of MST as an effective intervention in psychiatric disorders with a cognitive profile that is potentially more favourable than ECT.
目的
定性和定量综合关于磁休克疗法（MST）治疗精神疾病的疗效和安全性的文献。
方法
对OVID Medline、OVID EMBASE、PsychINFO、CINAHL、Web of Science和Cochrane数据库进行文献检索，检索时间从建库至2024年1月14日，使用“磁休克疗法”的主题词和关键词。纳入随机对照试验（RCT）、RCT的事后分析、开放标签试验或病例系列研究，这些研究针对确诊精神疾病的成年人调查MST，并报告两个可能的主要结局：（1）精神症状减轻（通过有效评分量表测量）或（2）神经认知结局（通过标准化测试测量）。排除摘要、个案报告、综述和社论。提取的数据包括：（1）研究基本细节；（2）研究设计；（3）样本量；（4）基线人口统计学数据；（5）结局数据（包括自杀意念和不良事件的次要结局）；以及（6）刺激参数。应用Cochrane偏倚风险工具。对抑郁症研究进行定量分析，使用Hedge's g效应量。
结果
共有24项研究（n = 377）符合纳入标准。总结了17项抑郁症研究（包括3项RCT）、4项精神分裂症研究（包括1项RCT）、1项双相情感障碍研究、1项强迫症研究和1项边缘性人格障碍研究。我们发现，在随机对照试验中，MST与电休克疗法（ECT）在减轻抑郁症状方面无显著差异（ECT的g = 0.207，95%置信区间（CI）-0.132至0.545，P = 0.232）。在汇总的RCT和开放标签分析中，我们发现MST总体上能显著减轻抑郁症状（g = 1.749，CI 1.219至2.279，P < 0.005）。提示MST有适度的认知副作用。
结论
有必要进行大规模RCT，以确认MST作为一种有效干预精神疾病的早期信号，其认知特征可能比ECT更有利。
