Magnetic Seizure Therapy for Schizophrenia
Background
Schizophrenia is a severe psychiatric disorder, which is generally treated with medication; however, around one third of people do not fully respond to this treatment (treatment resistant schizophrenia; TRS).
Electroconvulsive therapy (ECT) uses electrical stimulation to stimulate the brain and induce a seizure, whilst under general anesthesia. It has been in use for several decades, for a variety of psychiatric conditions, and has been proven to be effective in patients with treatment resistant schizophrenia. However, ECT is controversial and commonly misunderstood, and can be associated with significant cognitive side effects (related to thinking), such as memory loss. This means it is not used very often in schizophrenia patients.
Magnetic seizure therapy (MST) is a newer treatment, which induces therapeutic seizures using magnetic stimulation while under general anesthesia. MST is an investigational treatment and has not yet been approved by Health Canada for clinical use outside of research studies like this one. Because it can be focused on a specific area of the brain, MST has been reported to cause minimal adverse cognitive effects.
Objective
In this study we want to see how effective ECT and MST are at treating treatment resistant schizophrenia, and to examine the side effects, especially cognitive side effects (related to thinking), of both treatments.
Study Details
Approximately half of the people enrolled in the study will receive ECT and half will receive MST treatment. The preparation process for treatments will be the same. Both involve general anaesthetic, meaning you will be unconscious for approximately 5-7 minutes. Which group you will be assigned to will be decided randomly (by chance). This study is a double-blind study. This means that neither you, the people doing your assessments, nor your regular health care providers will know which treatment you are receiving. Requests to reveal your assignment for your information or participation in other research studies will not be considered until this study has been completed and the results are known.
Because you will be receiving a general anaesthetic, you cannot have anything to eat and cannot drink any non-clear liquids after midnight the night before your treatment. You may drink clear liquids (e.g., water or apple juice) up to two hours before treatment. You MUST have an escort to take you home after each of your treatments. An escort may be a relative, friend, neighbour, case worker, etc. A taxi driver is not considered a suitable escort.
We will collect detailed information about your psychiatric history and symptoms, and will ask you to complete questionnaires and assessments of your cognitive functioning. We will collect information before treatment, after every few treatments, immediately after the treatment course is complete, and 6 months after the treatment course is complete.
Treatment Schedule
You will be asked to complete up to 15 treatments total (on Tuesdays and Thursdays) taking approximately 9 weeks. Please note that the duration of your visit to UBC will vary based on wait times in the clinic, but the treatment (including preparation and recovery) takes approximately 2 hours.
The Team
The study is being conducted by researchers at the University of British Columbia (UBC) and the Centre for Addictions and Mental Health (CAMH) in Ontario. The primary investigator in Vancouver is Dr Fidel Vila-Rodriguez, director of the NINET lab at UBC Hospital.
You may be eligible if…
- You are 19 years of age or older
- You have been diagnosed with Schizophrenia or Schizoaffective Disorder
- You have not achieved an appropriate response to at least 2 medications
- You are currently taking anti-psychotic medication and agree to keep your medication constant during the 9 weeks of treatment
- You meet all safety criteria to receive treatments
If you are considering participating in the MAST trial, please inform us…
- If you are pregnant or thinking of becoming pregnant
- Of all the medications that you are taking, including herbal supplements and over-the-counter medication (how often you take them, and what the dosages are)
- If you have a personal or family history of seizures
- If you have any past injuries, surgeries, or any other physical or mental health problems
- If you have:
- Aneurysm clips or coils
- Stents in the neck or brain
- Implanted stimulators (e..g, cardiac pacemakers or implantable cardioverter defibrillator (ICD))
- Metallic implants in your ears and eyes (e.g., dental implants, cochlear implants)
- Hearing aids
- Shrapnel or bullet fragments in or near the head
- Facial tattoos with metallic or magnetic-sensitive ink
- Other metal devices or object implanted in or near the head
Interested? For more details regarding the study or to discuss enrolment, please contact us at (604)-822-7308 or email ninet.lab@ubc.ca
Frequently Asked Questions
Your confidentiality will be respected. No information or records that disclose your identity will be published without consent, nor will any of your information or records that disclose your identity be removed or released without your consent, unless required by law.
Nothing! You will not be charged for the neurostimulation treatment or any tests that you undergo while in this study.
The potential benefits of participating include being provided careful medical monitoring over the course of the study and, possibly, improvement in your schizophrenic symptoms. However, no benefits from this study can be guaranteed.
Information learned from this study may be used to develop future studies that may benefit others. In general, we hope that the information learned from this study can be used in the future to benefit other people with depression and related diseases
The actual way that ECT relieves symptoms of illness is unknown. It is now believed that ECT affects some of the chemicals that transfer impulses or messages between nerve cells in the brain, so it may correct some of the biochemical changes that accompany some mental disorders. Each treatment procedure involves passing a small, controlled electric current between two metal discs (electrodes) that are applied on the surface of the scalp and/or temple. The current passes between the electrodes and through part of the brain in order to stimulate the brain. It causes a controlled therapeutic seizure that usually lasts 20 to 90 seconds.
Each treatment is given while you are asleep under general anaesthesia. The anaesthetic (the drug that will put you to sleep) is injected by an anesthesiologist (a doctor who specializes in giving the medicine) through a needle inserted in a vein. You will be given oxygen through a face mask. Your heart rate, blood pressure and oxygen level are monitored during the treatment. You will be asleep for about 5-10 minutes.
In MST, high intensity magnetic field pulses are delivered through a magnetic coil. Rapidly alternating strong magnetic field pulses pass freely into a focused area of the brain and create a seizure. Stimulation is limited to a focused area in the brain and, therefore, has minimal effect on the surrounding brain tissue.
Each treatment is given while you are asleep under general anaesthesia. The aesthetic (the drug that will put you to sleep) is injected by an anesthesiologist (a doctor who specializes in giving the medicine) through a needle inserted in a vein. You will be given oxygen through a face mask. Your heart rate, blood pressure and oxygen level are monitored during the treatment. You will be asleep for about 5-10 minutes.