Data_Sheet_1_Magnetic Seizure Therapy Compared to Electroconvulsive Therapy for Schizophrenia: A Randomized Controlled Trial.pdf

Background: Magnetic seizure therapy (MST) is a potential alternative to electroconvulsive therapy (ECT). However, reports on the use of MST for patients with schizophrenia, particularly in developing countries, which is a main indication for ECT, are limited.
Methods: From February 2017 to July 2018, 79 inpatients who met the DSM-5 criteria for schizophrenia were randomized to receive 10 sessions of MST (43 inpatients) or ECT (36 inpatients) over the course of 4 weeks. At baseline and 4-week follow-up, the Positive and Negative Syndrome Scale (PANSS) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were used to assess symptom severity and cognitive functions, respectively.
Results: Seventy-one patients who completed at least half of the treatment protocol were included in the per-protocol analysis. MST generated a non-significant larger antipsychotic effect in terms of a reduction in PANSS total score [g = 0.17, 95% confidence interval (CI) = −0.30, 0.63] and response rate [relative risk (RR) = 1.41, 95% CI = 0.83–2.39]. Twenty-four participants failed to complete the cognitive assessment as a result of severe psychotic symptoms. MST showed significant less cognitive impairment over ECT in terms of immediate memory (g = 1.26, 95% CI = 0.63–1.89), language function (g =1.14, 95% CI = 0.52–1.76), delayed memory (g = 0.75, 95% CI = 0.16–1.35), and global cognitive function (g = 1.07, 95% CI = 0.45–1.68). The intention-to-treat analysis generated similar results except for the differences in delayed memory became statistically insignificant. Better baseline cognitive performance predicted MST and ECT response.
Conclusions: Compared to bitemporal ECT with brief pulses and age-dose method, MST had similar antipsychotic efficacy with fewer cognitive impairments, indicating that MST is a promising alternative to ECT as an add-on treatment for schizophrenia.
Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT02746965.

背景：磁性惊厥治疗（Magnetic Seizure Therapy, MST）是电抽搐治疗（Electroconvulsive Therapy, ECT）的潜在替代疗法。然而，针对精神分裂症患者使用MST的相关报道较为有限，尤其是在发展中国家——而精神分裂症正是ECT的主要适应证之一。
方法：2017年2月至2018年7月，79名符合《精神障碍诊断与统计手册第5版（Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, DSM-5）》精神分裂症诊断标准的住院患者被随机分组，在4周周期内接受10次MST（43名住院患者）或ECT（36名住院患者）治疗。于基线及4周随访时，分别采用阳性与阴性症状量表（Positive and Negative Syndrome Scale, PANSS）及神经心理状态评估可重复成套测验（Repeatable Battery for the Assessment of Neuropsychological Status, RBANS）评估症状严重程度与认知功能。
结果：本研究纳入完成至少半数治疗方案的71名患者进行符合方案集分析。在PANSS总分降低与治疗应答率方面，MST展现出稍大但无统计学意义的抗精神病效应[标准化均数差（g）=0.17，95%置信区间（confidence interval, CI）=-0.30~0.63；相对危险度（relative risk, RR）=1.41，95% CI=0.83~2.39]。24名受试者因严重精神病性症状未能完成认知评估。相较于ECT，MST在即刻记忆（g=1.26，95% CI=0.63~1.89）、语言功能（g=1.14，95% CI=0.52~1.76）、延迟记忆（g=0.75，95% CI=0.16~1.35）及整体认知功能（g=1.07，95% CI=0.45~1.68）方面的认知损害程度显著更轻。意向治疗分析得到了相似结果，仅延迟记忆的组间差异不再具有统计学显著性。基线认知功能更佳可预测MST与ECT的治疗应答。
结论：相较于采用短脉冲双侧颞叶ECT及年龄-剂量给药方案的治疗方式，MST具有相当的抗精神病疗效，且认知损害更少，提示MST作为精神分裂症的附加治疗手段，是ECT颇具前景的替代疗法。
临床试验注册：ClinicalTrials.gov，编号：NCT02746965。