Table 1.
Author | Objective | Subjects | MST device and parameters | ECT device and parameters | Study design | Anesthetics | Cognitive and physiologic outcomes | Clinical outcomes |
---|---|---|---|---|---|---|---|---|
Lisanby et al., 2003 [22] | Assert the safety and feasibility of MST for MDD1 | N = 10 (MDD) | 50 Hz modified Magstim; first session titration for ST2, followed by sessions 0.5 ms PW3and 60 Hz at 100% output | Mecta 5000 Q; 0.5 ms pulse width; 9 patients RUL4-ECT x6 ST + 1 patient BL5-ECT 2.5x ST | Double-blind within subject crossover MST × ECT | Atropine 0.4 mg/Kg IV; methohexital 0.75 mg/Kg IV; succinylcholine 0.75 mg/Kg IV | MST superior to ECT on multiple cognitive domains; MST elicited shorter seizures | N/A |
White et al., 2006 [43] | Evaluation of anesthetic aspects of MST | N = 20 (MDD) | 50 Hz modified Magstim; first session titration for ST, followed by sessions at 1.3x ST | Mecta 5000 Q; BF6-ECT, 0.5 ms PW; 2.5x ST | Double-blind randomized trial MST × ECT | Etomidate 0.15–0.20 mg/Kg IV; succinylcholine 0.5–1.0 mg/Kg IV; glycopyrrolate 2.5 mcg/Kg IV; ketorolac 0.4 mg/Kg | MST resulted in lower variation on BIS7 and faster reorientation | ECT reduced HAM-D8 from 30 to 6; MST reduced HAM-D from 32 to 14 after 10–12 sessions |
Kirov et al., 2008 [47] | Assessment of reorientation time after HD-MST9 | N = 11 | 100 Hz modified Magstim; PW 0.34–0.4 ms, 10 s stimulus for all patients | Not specified | Double-blind crossover MST × ECT | Etomidate 0.15–0.3 mg/Kg IV; succinylcholine 0.5–1.0 mg/Kg IV | MST faster reorientation (7 : 12 min) compared to ECT (26 : 35 min) | N/A |
Kayser et al., 2011 [44] | Effectiveness and safety of MST compared to ECT | N = 20 (16 MDD, 3 BP-II10 and 1 BP-I11) | 100 Hz MagVenture MST MagPro; 0.37 ms PW; | Thymatron IV; 0.5 PW, RUL-ECT, 3x ST | Double-blind randomized trial MST × ECT | Propofol 1.5–2.5 mg/Kg IV; succinylcholine 1–1.5 mg/Kg IV | No cognitive loss on either group | MST: 60% response and 30% remission; ECT 40% response |
Kayser et al., 2013 [48] | Assessment of cognitive and seizure characteristics of HD-MST and ECT | N = 7 (6 MDD, 1 BP-II) | 100 Hz MagVenture MST MagPro; | Thymatron IV; 0.5 ms PW, 0.9 A, 30–120 Hz; 5 patients RUL-ECT 6x ST, 2 patients BL-ECTG 3x ST | Open-label, follow-up of MST after failure to respond to ECT | Propofol 1.0–1.5 mg/Kg IV; 1.0–1.5 mg/Kg succinylcholine IV | Shorter reorientation after MST; seizures similar, but shorter after MST | N/A |
Hoy et al., 2013 [46] | Effects of MST on brain glucose metabolism | N = 10 (MDD) | 100 Hz MagVenture MST; 400 pulses above ST | N/A | Open label | Propofol (mean dose 122.13 mg IV); succinylcholine (mean dose 53.61 mg IV) | Glucose metabolism increased in several areas | 57% of response after treatment |
Fitzgerald et al., 2013 [45] | Effectiveness and safety of MST | N = 13 (MDD) | 100 Hz MagVenture MST MagPro; 10 s stimulus for first patient; 400 pulses above ST for all others | N/A | Open-label study | Propofol (mean dose 124.0 ± 24.1 mg IV); succinylcholine (mean dose 52.7 ± 12.2 mg IV) | Fast reorientation with patients reporting awakening under muscle relaxation | Five patients responded, two of which achieved remission |
Polster et al., 2014 [49] | Compare acute memory retrieval of MST and ECT | N = 30 (20 MDD + 10 controls) | 100 Hz MagVenture MST MagPro; suprathreshold stimulation; 2x week | Thymatron IV; 0.5 ms PW, RUL-ECT, 5x ST; 2x week | Open-label study | Propofol 1.5 mg/Kg IV; succinylcholine 1.0 mg/Kg V | Delayed recall disturbed after ECT but not after MST | N/A |
Notes. 1 Major depressive disorder; 2seizure threshold; Hamilton Depression Rating Scale; 3pulse width; 4right unilateral electrodes; 5bitemporal electrodes; 6bifrontal electrodes; 7electroencephalographic bispectral index; 8Hamilton Depression Rating Scale; 9high-dose magnetic seizure therapy; 10bipolar disorder, Type II; 11bipolar disorder, Type I.