A Randomized Controlled Trial Of Magnetic Seizure Therapy On Patients With Schizophrenia

Objective: Magnetic seizure therapy(MST)is a potential alternative to electroconvulsive therapy(ECT).So far,MST studies were focused on depression,resulting in a lack of reports about MST in patients with schizophrenia,which is a main indication for ECT.The aim of the current trial was to investigate the efficacy,safety,and neural plasticity effects of adjunctive MST on schizoohrenia with a randomized controlled design.Methods: Seventy-nine inpatients with schizophrenia were randomized to receive ten sessions of MST or ECT in four weeks.At baseline and four-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.In addition,T1,diffuse tensor,and resting-state functional images were acquired with a 3T scanner.Results: MST yield a comparable response rate to ECT(64.9 % vs.52.9 %).ECT impaired immediate memory,delayed memory,and language function,while MST improved immediate memory and language function.Both MST and ECT affected attention.Seizure therapies decreased the grey matter volume in the left frontal cortex.Responders showed larger grey matter volume reduction in widespread regions.ECT produced larger reduction in the regional homogeneity(Re Ho)within the cerebellum.Patients with delayed memory impairment had larger increases in the voxel-mirrored homotopic connectivity(VMHC)within the bilateral insula.The changes in topological properties(efficiency,local efficiency,small-world charactieristics,betweeness centrality,and degree centrality)after MST and ECT provided additional insight into the mechanisms underlying the efficacy and the cognitive side-effects of seizure therapies.Besides,the average connectivity strength between the sensorimotor network and the dorsal attention network,between the salience network and the frontoparietal network,between the frontoparietal network and the language network,within the sensorimotor network,within the salience network,and within the dorsal attention were enhanced after seizure therapies.Age,disease duration,clozapine resistence,cognitive functions,and diffusion tensors at baseline are potential predictors of response;gender,seizure-induced method,delayed memory,and local diffusion homogeneity at baseline are potential predictors of delayed memory inpairment.Conclusions: Compared to ECT,MST had comparable antipsychotic efficacy with less cognitive impairments.These phenomena were associated with their patterns on the neural modulation of the grey matter volume and the topological properties of the structural and functional networks.