ECT & rTMS & Magnetic Seizure Therapy
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Q:  What is new with EST and Magnetic Resonance Treatment and BipolarII? Anything promising ?


Dear Ms. F' -- 
As though you were a "plant" in the audience, asking the leading question at just the right moment, there are a couple of "new" things: 

1.  EST -- a new acronym?  Or mean you ECT, for electroconvulsive therapy, where nope there's no new news specific to Bipolar II.  The only "new" thing I've heard there is an article indicating new concerns about maintenance ECT (where a person gets repeated single ECT sessions, usually about a month apart, to maintain an improvement that ECT yields but which cannot be maintained using psychotherapy/medications/exercise but instead only ECT).  The new concern is that repeated ECT leads to some lasting cognitive impairment Rami-Gonzales, unlike the short-term impairment following each session which typically resolves within weeks.  Thus there is this small new bit of data to further spur interest -- mine, anyway -- in the magnetic approaches. 

In repetitive Transcranial Magnetic Stimulation (rTMS), the magnet used is as strong as that used for MRI studies, 1-2 tesla -- in other words, this is nothing at all like a magnet someone might try to sell over the internet to put around your wrist!  For a few more references on the ECT and rTMS, read another letter on this site

Perhaps you know of a new acronym, but the only other treatment I know of that's new in this area is called magnetic seizure therapy.  Basically it's a cross between ECT and TMS, where a seizure is induced using a TMS magnet instead of using electrical current.  In one reportLisanby, there was less memory impairment (which is the main problem in terms of ECT side effects).  

2.  There are two remaining magnet manufacturers in the world, apparently; the third one went out of business waiting for FDA approval after they submitted what they thought would gain that approval and were turned down.  I've had some interesting conversations recently with a researcher who's been studying the magnet for years, and the head of one of the remaining magnet-producing companies.  There are some pretty complex policy decision-making processes going on and it sounded to me as though waiting for FDA approval of this device may be a long wait even yet.  There is a European company selling the device, and it is apparently being used fairly widely in Europe and Canada.  One of the main research groups studying it is in Israel (may there be peace among Muslims, Christians, and Jews in our lifetime...). 

In the last month I've been studying what it would take to get underway with a magnet in the U.S. as an "off-label" treatment, just as we use many medications off-label.  This is proving to be very complicated but is not looking impossible yet.  There should be some news in this respect soon.  However, anything that looked like "advertising" of the magnet treatment is not allowed under the FDA "labeling" process, just as any drug that is used "off-label" cannot be advertised by its manufacturers for that purpose (you should see how the companies try to wiggle around that one!).  So if I was ever to get underway with the magnet treatment in Corvallis, I could not do anything that looked like advertising of same -- but I could respond to questions, just as to yours now.  If something actually happens, I'll try in some fashion to indicate that more detailed questions would be acceptable (there's no point in that just yet).  

As you can gather, I am convinced myself from the literature that the magnet is sufficiently safe and sufficiently effective to warrant it's use when more conventional treatments have not been successful.  It is not something to be used before treatments we currently have more experience with.  But when people need an alternative to those, and would be considering ECT for example, I think rTMS is a tool we need to have available.  I've been working on this recently for a couple of patients who are in just this position, and I wish it was ready right now.  

Dr. Phelps


Published March, 2003
 

 

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