Key messages
There were too scarce data to evaluate the benefits and risks of magnetic seizure therapy (MST) for people with schizophrenia.
We need more and better studies to look into this.
What is schizophrenia?
Schizophrenia is one of the most common and disabling mental disorders. People with schizophrenia may have difficulties living a normal life due to the illness, which may include distorted beliefs despite reality, hearing voices created by their minds, and having no interest in caring for others or themselves.
Why is this important for people with schizophrenia?
Most people with schizophrenia receive antipsychotic treatments. For those who don't respond well to antipsychotics or wish to use alternative treatments, electroconvulsive therapy (ECT) could be an effective and safe choice. This therapy causes a seizure in an anaesthetised person by electric currents applied to the brain; in this way, psychotic symptoms are improved or relieved. However, ECT has side effects such as temporary memory loss, and confusion after treatments, which limits its use. Magnetic seizure therapy is one of the novel non-invasive brain stimulation techniques, which works like ECT by inducing a seizure, however not with electric currents but with magnetic energy fields, which theoretically would cause less risk of memory loss or confusion after the treatments.
What did we want to find out?
We wanted to know whether MST helps people with schizophrenia.
We were interested in:
- number of people with symptoms improved;
- number of people with impaired cognitive function;
- number of people with clinically important side effects.
What did we do?
We searched for studies that investigated the effect of MST compared to any other treatments for people with schizophrenia.
We compared and summarised the results of the study and rated our confidence in the evidence, based on factors such as study methods and sizes.
What did we find?
Main results
We found one short-term randomised controlled trial (RCT) with 79 adults that met the review requirements. It compared MST plus standard care to ECT plus standard care. Our findings were based on very limited data. We found that MST and ECT may be comparable in improving the global state of people with schizophrenia, and in improving the overall, positive and negative symptoms of schizophrenia. MST may cause less delayed memory deficit and less cognitive deterioration and may improve cognitive function compared to ECT. There may be no difference between the two groups in terms of leaving the study early due to any reason, adverse effects, or inefficacy. We cannot conclude whether MST is helpful or safe for people with schizophrenia based on limited data. Well-designed RCTs are warranted to answer the question.
How up-to-date is this evidence?
The evidence is up-to-date to 06 March 2022.
Due to the paucity of data, we cannot draw any conclusion on the efficacy and tolerability of MST for people with schizophrenia. Well-designed RCTs are warranted to answer the question.
Schizophrenia is one of the most common and disabling mental disorders. About 20% of people with schizophrenia do not respond to antipsychotics, which are the mainstay of the treatment for schizophrenia today, and need to seek other treatment options. Magnetic seizure therapy (MST) is one of the novel non-invasive brain stimulation techniques that are being investigated in recent years.
To evaluate the efficacy and tolerability of MST for people with schizophrenia.
On 6 March 2022, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials which is based on CENTRAL, CINAHL, ClinicalTrials.Gov, Embase, ISRCTN, MEDLINE, PsycINFO, PubMed, and WHO ICTRP.
All randomised controlled trials (RCTs) comparing MST alone or plus standard care with ECT or any other interventions for people with schizophrenia.
We performed reference screening, study selection, data extraction and risk of bias and quality assessment in duplicate. We calculated the risk ratios (RRs) and their 95% confidence intervals (CIs) for binary outcomes and the mean difference (MD) and their 95% CIs for continuous outcomes. We used the original risk of bias tool for risk of bias assessment and created a Summary of findings table using GRADE.
We included one four-week study with 79 adults in acute schizophrenia, comparing MST plus standard care to ECT plus standard care in this review. We rated the overall risk of bias as high due to high risk of bias in the domains of selective reporting and other biases (early termination and baseline imbalance) and unclear risk of bias in the domain of blinding of participants and personnel.
We found that MST and ECT may not differ in improving the global state (n = 79, risk ratio (RR) 1.12, 95% confidence interval (CI) 0.73 to 1.70), overall (n = 79, mean difference (MD) -0.20, 95% CI -8.08 to 7.68), the positive symptoms (n = 79, MD 1.40, 95% CI -1.97 to 4.77) and the negative symptoms (n = 79, MD -1.00, 95% CI -3.85 to 1.85) in people with schizophrenia.
We found that MST compared to ECT may cause less delayed memory deficit and less cognitive deterioration (n = 79, number of people with a delayed memory deficit, RR 0.63, 95% CI 0.41 to 0.96; n = 79, mean change in global cognitive function, MD 5.80, 95% CI 0.80 to 10.80), but also may improve more cognitive function (n = 47, number of people with any cognitive improvement, RR 3.30, 95% CI 1.29 to 8.47).
We found that there may be no difference between the two groups in terms of leaving the study early due to any reason (n = 79, RR 2.51, 95% CI 0.73 to 8.59), due to adverse effects (n = 79, RR 3.35, 95% CI 0.39 to 28.64) or due to inefficacy (n = 79, RR 2.52, 95% CI 0.11 to 60.10).
Since all findings were based on one study with high risk of bias and the confidence in the evidence was very low, we were not sure these comparable or favourable effects of MST over ECT were its true effects.