Magnetic Seizure Therapy And Electroconvulsive Therapy For Ultra-treatment-resistant Schizophrenia: A Parallel Control Pilot Study

Objectives: The study aims to compare the efficacy and safety of MST and MECT on ultra-treatment-resistant schizophrenia(URS).Methods: A randomized,parallel-group,controlled clinical trial was undertaken.16 URS patients were randomly allocated to receive 10 sessions of add-on MST or MECT over 4 weeks with a 1:1 ratio,and continued clozapine monotherapy until 8 weeks follow-up.Efficacy and safety of treatment were assessed at baseline,week 4 and week 8.Results:(1)PANSS scores: 4-week MST treatment produced improvements from baseline in PANSS total,PANSS positive,PANSS negative and PANSS general psychopathology(mean±SE:18.13±14.24,5.63±5.68,5.25±5.52 and 7.50±7.35,respectively [p<0.05]),while significant reductions in PANSS total and PANSS positive were also observed at 8-week follow-up(mean±SE:22.17±20.99,and 8.67±7.50,respectively[p<0.05]).4-week MECT treatment produced improvements from baseline in PANSS total and PANSS positive(mean±SE:8.88±9.66 and 5.00±2.78,respectively[p<0.05]),while significant reductions in PANSS positive were also observed at 8-week followup(mean±SE:6.67±5.96[p<0.05]).Treatment with MST resulted in significant improvements versus MECT in PANSS negative from baseline to week 8(p=0.042).(2)RBANS scores: Pre and post neurocognitive data showed no significant cognitive adverse effects in both groups.MST influenced immediate memory less than MECT(p=0.030).(3)Lab examination: Pre and post laboratory data showed no significant changes in both groups.The neutrophil ratio was higher in MECT group than MST group after treatment(p=0.011).Conclusions: In this pilot study,MST and MECT equally improved the positive symptoms of URS,while MST tended to be more effective in the negative symptoms. MST demonstrated evidence for negligible cognitive side effects,with less effect on immediate memory than MECT.Further study in larger clinical populations is needed.