Magnetic seizure therapy versus electroconvulsive therapy for treatment‑resistant schizophrenia

Magnetic Seizure Therapy for Schizophrenia - Trial

This trial will test whether magnetic seizure therapy works as well as a specific form of electroconvulsive therapy for adults whose schizophrenia or schizoaffective disorder has not improved with medications.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 80 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Centre for Addiction and Mental Health (Academic / other)
• Locations: 2 sites (Vancouver, British Columbia and 1 other locations)
• Trial ID: NCT06672588 on ClinicalTrials.gov

What this trial studies

This is a randomized, double‑blind, non‑inferiority trial conducted at two Canadian academic centres comparing magnetic seizure therapy (MST) to right unilateral ultrabrief pulse electroconvulsive therapy (RUL‑UB‑ECT). Treatments are given two to three times per week and clinical response is measured primarily by a 40% or greater reduction on the BPRS positive psychotic symptom subscale. Participants who do not meet response criteria after up to 15 sessions stop treatment, and blinding is maintained until study completion. The trial targets adults with chronic, treatment‑resistant schizophrenia or schizoaffective disorder who are judged appropriate for convulsive therapy.

Who should consider this trial

Good fit: Adults (18+) with a DSM‑5 diagnosis of schizophrenia or schizoaffective disorder for at least 2 years, who are treatment‑resistant after two adequate antipsychotic trials, have significant psychotic symptoms on the BPRS, can consent, and are considered appropriate for convulsive therapy are eligible.

Not a fit: People with less severe symptoms, who are not treatment‑resistant, who have medical contraindications to convulsive therapy or anesthesia, or who fail to respond after 15 sessions are unlikely to benefit from participation.

Why it matters

Potential benefit: If successful, MST could provide similar symptom relief to ECT while potentially causing fewer cognitive side effects.

How similar studies have performed: ECT has a long-established record of effectiveness for treatment‑resistant psychosis, while MST is a newer alternative with encouraging early data but limited large randomized evidence so far.

Eligibility criteria

Inclusion Criteria:

1. are inpatients or outpatients;
2. demonstrate capacity to consent according to the MacArthur competence assessment tool for clinical research (MacCAT-CR);
3. have a DSM-5 diagnosis of Schizophrenia or Schizoaffective Disorder for at least 2 years, as determined by the MINI International Neuropsychiatric Interview - Version 7 (MINI-7.0);
4. are 18 years of age or older;
5. have demonstrated resistance to at least 2 antipsychotics of 600 mg of chlorpromazine equivalents for at least 6 weeks;
6. have a BPRS score at baseline of at least moderate severity (\>4) on one of the four psychotic items (i.e., hallucinatory behavior, suspiciousness, conceptual disorganization, unusual thought content) or at least 12 on these 4 items combined;
7. are considered to be appropriate to receive convulsive therapy as assessed by an ECT attending psychiatrist and a consultant anaesthesiologist;
8. are on an antipsychotic at an adequate dose and are agreeable to keeping their current antipsychotic treatment constant during the acute phase of the intervention;
9. are able to adhere to the intervention schedule;
10. meet the MST safety criteria;
11. If a woman of child-bearing potential: is willing to provide a negative pregnancy test and agrees not to become pregnant during trial participation.

Exclusion Criteria:

1. have a history of MINI diagnosis of a substance use disorder (other than nicotine and caffeine) within the past three months;
2. have a concomitant major unstable medical illness;
3. are pregnant or intend to get pregnant during the study;
4. have probable dementia based on study investigator assessment;
5. have any significant neurological disorder or condition likely to be associated with increased intracranial pressure or a space occupying brain lesion, e.g., cerebral aneurysm;
6. present with a serious medical condition,
7. have an intracranial implant (e.g., aneurysm clips, shunts, stimulators, cochlear implants, or electrodes) or any other metal object within or near the head, excluding the mouth, that cannot be safely removed;
8. require a benzodiazepine with a dose \> lorazepam 2 mg/day or equivalent or any anticonvulsant due to the potential of these medications to limit the efficacy of both MST and ECT;
9. are unable to communicate in English fluently enough to complete the neuropsychological tests;
10. have a non-correctable clinically significant sensory impairment (i.e., cannot hear or see well enough to complete the neuropsychological tests).

Where this trial is running

Vancouver, British Columbia and 1 other locations

• University of British Columbia Hospital — Vancouver, British Columbia, Canada (Recruiting)
• Centre for Addiction and Mental Health — Toronto, Ontario, Canada (Recruiting)

Study contacts

• Principal investigator: Daniel Blumberger, M.D., MSc. — Centre for Addiction and Mental Health
• Study coordinator: Daniel Blumberger, MD., MSc.

Conditions Treatment Resistant Schizophrenia; Schizophrenia; Schizoaffective Disorder; Electroconvulsive Therapy; Magnetic Seizure Therapy; Convulsive Therapy