Confirming feasibility of magnetic seizure therapy in the Dutch setting (CometD)

Since its development in 1938, electroconvulsive therapy (ECT) has been used as
a treatment for mood disorders including Major Depressive Disorder (MDD) and
particularly, treatment-resistant depression (TRD). During a session of ECT, an
electrical current is applied to the scalp of an anesthetized patient which
induces a seizure as it passes through the brain. Despite the remission rates
between 50-70% [1], it remains one of the least used treatments for depression.
Fewer than 1% of patients with TRD receive ECT due to a combination of fear,
stigma, and concerns about cognitive side effects, such as short-term amnesia

The search for alternative, yet comparably effective, therapeutic stimulation
techniques has led to the development of treatments like repetitive
transcranial magnetic stimulation (rTMS) and more recently, magnetic seizure
therapy (MST). MST is a more focal treatment that was developed to mimic the
therapeutic effects of ECT while minimizing the adverse side effects.
Specifically, MST involves the application of a magnetic field to produce a
seizure in the brain.
Compared to ECT, MST can produce remission rates between 30-60% and patients
receiving MST experience fewer cognitive side effects and recover more quickly
after the procedure compared to patients receiving ECT . ECT and MST differ in
the characteristics of the induced seizure, with the ECT-induced seizure
spreading to deeper subcortical structures, including the hippocampus, while
the MST-induced seizure is more confined to the cortex.
Studies thus far indicate that MST has a comparable antidepressant effect to
unilateral ECT, although the impact on cognitive functions remains unclear.
So while international studies are promising and more are underway, we also
need to critically test the usefulness in the Dutch care setting. In the Dutch
setting, we however use brief-pulse ECT and based on the clinical
characteristics described, we often seem to have patients with a higher level
of treatment resistance. This may also be related to the fact that in the Dutch
stepped care model, there is a tendency to regard ECT as a last resort therapy.

We aim to conduct a pilot study investigating feasibility of MST within our
clinical setting. As an academic department, we are in the process of
identifying MRI biomarkers of successful convulsion therapy, at this point thus
based on ECT studies. Given that this feasibility study forms the basis for a
larger clinical trial, we will also explore the use of our structural and
functional markers in the group treated with MST.

Feasibility study whereby 10 patients will be treated with MST.

Treatment with MST, applied at 100 Hz at 100% of the maximum device power for
8-10 seconds. Treatment will be continued until a clinical plateau is reached.
We will use MRI and EEG measurements to identify potential markers for
structural and functional changes in the brain.

All psychiatric measurements are administered routinely at our out- and
inpatient depression
unit. The (f)MRI/EEG measurements will require a maximum of 60 minutes of the
patients time at one time before, after 6 treatments and after stop treatment.
Risks associated with these measurements are negligible.
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