Magnetic seizure therapy in bipolar mania patients enhance cognitive outcomes: JAMA

A recent study published in the Journal of American Medical Association found Magnetic Seizure Therapy (MST) as a potential alternative to Electroconvulsive Therapy (ECT) for treating bipolar mania by potentially offering fewer cognitive side effects. Bipolar disorder is characterized by extreme mood swings including emotional highs (mania) and lows (depression) which can significantly impair the quality of life. ECT has long been recognized as an effective treatment for severe cases of mania but comes with the drawback of potential cognitive adverse effects like memory loss. So, Shan Chen and team sought for a less invasive option and focused on MST that was not previously tested for bipolar mania.

The randomized clinical trial from the Shanghai Mental Health Center was conducted between July 2017 to April 2021 and included 48 patients who underwent severe episodes of mania. The patients were divided into two groups, where one group received ECT and the other group underwent MST. Both groups participated in 8 to 10 treatment sessions over several weeks with MST being delivered at 100% device output and a frequency of 75 Hz over the vertex. The effectiveness of the treatments was primarily measured by changes in the Young Manic Rating Scale (YMRS) score and the overall response rate was defined as a more than 50% reduction in YMRS score from baseline.

The findings revealed that both MST and ECT had high response rates with efficacy of 95% in the ECT group and 86.4% in the MST group. Also, the outcomes showed no significant difference in the reduction of mania symptoms between the these two therapies by affirming the comparable efficacy of MST. The key differentiator was in the cognitive outcomes, where patients in the MST group expressed significantly better preservation of cognitive functions in language skills when compared to the patients treated with ECT.

This trial is significant as it introduces MST as a pivotal treatment option that could reduce some of the cognitive drawbacks linked with traditional ECT. The outcomes of this study highlight the safety of both treatments as there were no serious adverse effects reported in either group. Overall, the findings of this study suggest that MST could be adopted as a standard therapy for bipolar mania management in patients who are at high risk of cognitive impairment.

Reference:

Chen, S., Sheng, J., Yang, F., Qiao, Y., Wang, W., Wen, H., Yang, Q., Chen, X., & Tang, Y. (2024). Magnetic Seizure Therapy vs Modified Electroconvulsive Therapy in Patients With Bipolar Mania. In JAMA Network Open (Vol. 7, Issue 4, p. e247919). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.7919