Magnetic Seizure Therapy and Other Convulsive Therapies Arielle D. Stanford, MD, Mustafa M. Husain, MD, Bruce M. Luber, PhD, Robert Berman, MD, Matthew D. Truesdale, BA, Shawn McClintock, MS, and Sarah H. Lisanby, MD f Drs. Stanford and Berman are postdoctoral clinical fellows, Dr. Luber is an instructor in clinical psychiatry, and Mr. Truesdale is research scientist the Department of Psychiatry at Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute in New York City. Dr. Husain is associate professor and Mr. McClintock is doctoral candidate in the Neurostimulation Lab and Program in the Department of Psychiatry at the University of Texas Southwestern Medical Center in Dallas. Dr. Lisanby is director of the Brain Stimulation and Neuromodulation Division in the Department of Psychiatry at Columbia University College of Physicians and Surgeons, and is associate professor of clinical psychiatry in the Department of Neuroscience at Columbia University, at the New York State Psychiatric Institute in New York City. Disclosure: Dr. Stanford is on the speaker’s bureau of Pfizer. Dr. Husain has received grant support from Neuronetics and the Stanley Medical Research Foundation. Dr. Lisanby is on the speaker’s bureau of Cyberonics; and has received grant support from the American Federation for Aging Research, Magstim Company Limited, the National Alliance for Research On Schizophrenia and Depression, the National Institute of Mental Health, Neuronetics, and the Stanley Medical Research Foundation. Dr. Luber, Dr. Berman, Mr. Truesdale, and Mr. McClintock report no affiliations with or financial interests in any organization that may pose a conflict of interest. Please direct all correspondence to Sarah H. Lisanby, MD, 1051 Riverside Drive, Unit 126, Brain Stimulation and Neuromodulation Division, New York State Psychiatric Institute, New York, NY 10032; Tel: 212-543-5558; Fax: 212-543-6056; E-mail: slisanby@columbia.edu. Psychiatric Institute, New York, NY 10032; Tel: 212-543-5558; Fax: 212-543-6056; E-mail: slisanby@columbia.edu. Clinical Focus Primary฀Psychiatry.฀2005;12(10):44-50 44 Primary Psychiatry © MBL Communications, October 2005 r Abstract 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 cur- rently being developed as a means to lower the side effects of ECT through enhanced control over the site of stimula- tion and seizure initiation. MST involves the induction of a seizure under general anesthesia using high-frequency repeti- anesthesia using high-frequency repeti- tive 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 stimu- lus across the scalp and skull results in significant shunting and offers little control over current spread. Since mag- netic fields pass through tissue without netic fields pass through tissue without impedance, MST offers the promise of more precise control over induced electri- cal current and seizure initiation. This article reviews the current status of MST, from device development, to preclini- cal 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 pre- sented and discussed. sented and discussed. 3 CME C Needs฀Assessment: ฀Convulsive฀therapies฀ induce฀ a฀ variety฀ of฀ opinions฀ in฀ profes- sional฀ and฀ public฀ audiences.฀ However, they฀ provide฀ much฀ benefit฀ to฀ treatment- resistant฀ patients฀ in฀ a฀ range฀ of฀ disorders.฀ The฀ development฀ of฀ magnetic฀ seizure฀ therapy฀ has฀ come฀ out฀ of฀ the฀ desire฀ to provide฀ a฀ convulsive฀ treatment฀ that฀ has the฀ efficacy฀ of฀ electroconvulsive฀ therapy without฀its฀cognitive฀side฀effects. Learning฀Objectives: •฀฀ Identify฀the฀current฀indications฀for฀electro- convulsive฀therapy฀(ECT)฀in฀psychiatry. •฀฀ Understand฀the฀differences฀between฀ECT and฀magnetic฀seizure฀therapy. •฀฀ Relate฀the฀advantages฀of฀ magnetic฀seizure฀ therapy ฀ over฀ y ECT ฀ and฀ how฀ this฀ impacts T patient฀populations. 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