Trial Platform - Reducing adverse ECT effects on memory by magnetic stimulation,

Lead Research Organisation: University of Edinburgh
Department Name: Sch of Molecular. Genetics & Pop Health

Abstract

Depression is of overwhelming public interest simply due to its fequency and the fact that many working hours and lives are lost through it. There is a public interest in making the treatments used as effective, evidence based and user friendly as possible. We, therefore, plan to make the study details and results publicly available, possibly under the umbrella of the Scottish ECT Audit (SEAN).

Technical Summary

Electroconvulsive Therapy (ECT) is the most controversial treatment regularly used in British psychiatry. Systematic reviews confirm it as one of the most effective treatments for depression, particularly for the more severe, psychotic form (Kho et al., 2003; UK ECT Review Group, 2003; NICE Guidance: http://www.nice.org.uk/cat.asp?c=68305). Its effect on memory limits its usefulness: ECT interferes with the laying down of new memories and creates islands of memory loss sometimes as far back as 2 years before the treatment started (Donahue, 2000; Lisanby et al., 2000; Prudic et al., 2000; Tang et al., 2002). An urgent effort has, therefore, to be made to find a mode of convulsive treatment that minimises side effects on memory (NICE Guidance: http://www.nice.org.uk/cat.asp?c=68305).

While ECT relies on relatively large electric currents being applied across the head, which partially flow through brain tissue, but also over scalp and superficial muscles, MST (magnetIc seizure therapy) uses strong currents through an electrically insulated coil to create a focussed magnetic field that in turn can generate electric discharges in brain tissue directly under the stimulation coil. If the magnetic stimulus is applied at high frequency (50-100 Hz), the local nerve cell activity can generalise into a grand mal seizure (Kosel et al., 2003; Lisanby et al., 2003a; Lisanby et al., 2003b; Dwork et al., 2004; Morales et al. 2004).

It is thought that ECT side effects on memory are proportional to the amount of electric energy applied to brain tissue. The efficacy of ECT is thought to depend on the precipitation of a seizure. Thus causing a seizure with a minimum of electric current flow should result in the most advantageous balance of costs and benefits. Elaborate techniques have been developed to minimise the energy applied: by building up the current over the first few treatments which results in suboptimal first treatments, or limiting stimulation to the right brain hemisphere. These manoeuvres tend to result in reduced efficacy (Sackeim et al., 2000).

We propose a randomised controlled pilot trial (Trial Platform) of ECT as usual versus MST, predicting that MST causes less cognitive disturbance in patients than ECT, while retaining its efficacy within the power available.

Publications

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Allan C (2012) Transcranial stimulation in depression. in The British journal of psychiatry : the journal of mental science

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Allan C (2018) Review of treatment for late-life depression in Advances in Psychiatric Treatment

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Allan CL (2012) Prophylaxis and treatment of bipolar disorder in older adults. in Journal of psychiatry & neuroscience : JPN

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Allan CL (2011) The use of ECT and MST in treating depression. in International review of psychiatry (Abingdon, England)

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Ebmeier KP (2008) TMS--the beginning of the end or the end of the beginning? in Psychological medicine

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Herrmann LL (2007) The cognitive neuropsychology of depression in the elderly. in Psychological medicine

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Herrmann LL (2008) White matter hyperintensities in late life depression: a systematic review. in Journal of neurology, neurosurgery, and psychiatry

 
Description Data sharing with Cardiff Group 
Organisation Cardiff University
Department Division of Psychological Medicine and Clinical Neurosciences
Country United Kingdom 
Sector Academic/University 
PI Contribution Data sharing
Collaborator Contribution Data sharing
Impact Publication in BJPsych
Start Year 2006
 
Description MST in Depression 
Organisation Columbia University
Country United States 
Sector Academic/University 
PI Contribution Experimental design, recruitment of cases, experimental results, publication
Collaborator Contribution Clinical Expertise
Impact PMID: 18670002 PMID: 18379329 PMID: 17935637 PMID: 17194264 PMID: 16413879
 
Title MST 
Description Magnetic Seizure Therapy 
Type Therapeutic Intervention - Psychological/Behavioural
Current Stage Of Development Early clinical assessment
Year Development Stage Completed 2008
Development Status Under active development/distribution
Impact Possible alternative to ECT 
 
Description ACNP 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Health professionals
Results and Impact ACNP ECT Panel, Focal seizure initiation with Magnetic Seizure Therapy (MST): Comparisons with ECT in Neurophysiological, Neuroplastic, Neurocognitive, and Antidepressant Outcomes

American College of Neuropsychopharmacology (ACNP) 2007 - Lisanby, Sarah H.; Kirov, George; McClintock, Shawn M.; Spellman, Timothy; Scott, Allan; Husain, Mustafa M.; Luber, Bruce; Terrace, Herbert; Ebmeier, Klaus P. - Cognitive effects of high-dose Magnetic Seizure Therapy (MST) and ECT: Translational studies in depressed patients and nonhuman primates
Year(s) Of Engagement Activity 2008
 
Description American College of Neuropsychopharmacology 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Health professionals
Results and Impact Cognitive effects of high-dose Magnetic Seizure Therapy (MST) and ECT: Translational studies in depressed patients and nonhuman primates

American College of Neuropsychopharmacology 2008 - Lisanby; Arango, Cycowicz, Dwork, Ebmeier, Husain, Kirov, Luber, McClintock, Peterchev, Scalia, Scott, Spellman, Terrace, Underwood - Focal seizure initiation with Magnetic Seizure Therapy (MST): Comparisons with ECT in Neurophysiological, Neuroplastic, Neurocognitive, and Antidepressant Outcomes
Year(s) Of Engagement Activity 2007
 
Description Depression for not-yet medics 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Schools
Results and Impact Good student feedback 'didn't know psychiatry was so scientific'

Further requests for shadowing
Year(s) Of Engagement Activity 2014
 
Description Oxford Psychiatry 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Health professionals
Results and Impact Lecture: Brain stimulation and the treatment of depression

2007 Oxford Psychiatry Meeting - K Ebmeier - Brain stimulation and the treatment of depression
Year(s) Of Engagement Activity 2007
 
Description RCPsych 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Health professionals
Results and Impact RCPsych Celtic Meeting: Magnetic Stimulation Therapy for depression, efficacy and cognitive side effects

RCPsych Conference - Louisa Fraser, Lucy Carrick, Andy Stanfield, Allan Scott, Klaus Ebmeier - A New Type of Magnetic Seizure Therapy (MST): A Pilot Study
Year(s) Of Engagement Activity 2007
 
Description RCPsych Edinburgh 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Health professionals
Results and Impact A New Type of Magnetic Seizure Therapy (MST): A Pilot Study

RCPsych Edinburgh Conference - George Kirov, Najeeb Khalid, Maria Atkins, John Tredget, Maureen Giles, John Starzhevski, Andrew Thomas, Anthony Thomas, Mustafa Husain, Sarah H Lisanby - Magnetic seizure therapy (MST) a new treatment for depressive disorders
Year(s) Of Engagement Activity 2007
 
Description Spanish 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Health professionals
Results and Impact A closed conference for 20 senior Spanish psychiatrists University of Oxford Department of Psychiatry

2008 Oxford Meeting for Spanish Psychiatrists - K Ebmeier - The return of Mesmer? New (and old) physical treatments
Year(s) Of Engagement Activity 2008
 
Description Studienstiftung Greifswald Summer School 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Seminar format with 3 presentations by me and 17 by other (student) participants. Inreased understanding of psychiatry and depression and their relation to society in all participants

Several electives arranged.
Year(s) Of Engagement Activity 2014
URL http://en.wikipedia.org/wiki/Studienstiftung
 
Description Transcranial / transdermal stimulation techniques 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact talk sparked questions and discussion afterwards

talk resulted in further invitations to speak
Year(s) Of Engagement Activity 2014
 
Description World Congress Psychiatry 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Health professionals
Results and Impact "Magnetic seizure therapy at 100Hz for the treatment of depression: a pilot study" (WCP3616) for oral presentation. XIV World Congress of Psychiatry, Prague

2008 World Congress Psychiatry Prague - George Kirov, Najeeb Khalid, Maria Atkins, John Tredget and Maureen Giles; Mustafa Husain; Sarah H Lisanby; Klaus P. Ebmeier, Allan I F Scott, Lucy Carrick, Andrew Stanfield - Magnetic seizure therapy at 100Hz for the treatment of depression: a pilot study
Year(s) Of Engagement Activity 2008