Optimal Treatment of Magnetic Seizure Therapy (MST) in Patients with Clozapine-Resistant Schizophrenia (CRS).

Objective: The study aims to compare the clinical efficacy and cognitive side effect of magnetic seizure therapy (MST) and modified electroconvulsive therapy (MECT) on clozapine resistant schizophrenia (CRS).

Methods: Sixteen patients with CRS were enrolled in this randomized, parallel-group, controlled clinical trial. Patients were randomly allocated to receive 10 sessions of add-on MST or MECT over 4 weeks (1:1 ratio) and continued clozapine therapy during the study. Efficacy and neurocognition were assessed at baseline, 4-week and 8-week follow-up.

Results: (1) Clinical efficacy: MST significantly improved symptoms of schizophrenia from baseline to 4 weeks, as shown in PANSS total (p = 0.009), PANSS positive (p = 0.026), PANSS negative (p = 0.031) and PANSS general psychopathology (p = 0.023); we also observed significant reductions in PANSS total (p = 0.049) and PANSS positive (p = 0.037) at 8-week follow-up. MECT group also witnessed clinical improvement from baseline to 4-week in PANSS total (p = 0.035) and PANSS positive (p = 0.001); significant reduction in PANSS positive was also observed at 8-week follow-up (p = 0.041). From baseline to 8 weeks, PANSS negative had greater reduction in MST group compared with MECT group (p = 0.042). (2) Neurocognition: Pre-and post-treatment data showed no significant cognitive adverse effects in both groups. Immediate memory is better in patients who received MST than MECT at 4-week follow-up (p = 0.030).

Conclusion: In this pilot study, MST and MECT equally improved positive symptoms of CRS, while MST was more effective in relieving negative symptoms. Evidence showed negligible cognitive side effects in MST, with less adverse effect on immediate memory than MECT. As a promising alternative to MECT, MST requires further research in larger clinical population.