New directions in the rational design of electrical and magnetic seizure therapies: individualized Low Amplitude Seizure Therapy (iLAST) and Magnetic Seizure Therapy (MST)
Abstract
Electroconvulsive therapy remains a key treatment option for severe cases of depression, but undesirable side-effects continue to limit its use. Innovations in the design of novel seizure therapies seek to improve its risk benefit ratio through enhanced control of the focality of stimulation. The design of seizure therapies with increased spatial precision is motivated by avoiding stimulation of deep brain structures implicated in memory retention, including the hippocampus. The development of two innovations in seizure therapy-individualized low-amplitude seizure therapy (iLAST) and magnetic seizure therapy (MST), are detailed. iLAST is a method of seizure titration involving reducing current spread in the brain by titrating current amplitude from the traditional fixed amplitudes. MST, which can be used in conjunction with iLAST dosing methods, involves the use of magnetic stimulation to reduce shunting and spreading of current by the scalp occurring during electrical stimulation. Evidence is presented on the rationale for increasing the focality of ECT in hopes of preserving its effectiveness, while reducing cognitive side-effects. Finally, the value of electric field and neural modelling is illustrated to explain observed clinical effects of modifications to ECT technique, and their utility in the rational design of the next generation of seizure therapies.
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Low amplitude (200-400 mA) has been explored as part of individualized low-amplitude seizure therapy, but its clinical utility is yet to be understood.
“Recently, low amplitude (200–400 mA) has been explored as part of individualized low-amplitude seizure therapy.[20] Its clinical utility is yet to be understood.”
From Clinical Practice Guidelines for the Use of Electroconvulsive Therapy (2023) · cites this paper as [20]
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Key updates in the clinical application of electroconvulsive therapy
Weiner, R. D., & Reti, I. M. (2017) · International Review of Psychiatry · doi:10.1080/09540261.2017.1309362 · Cited by 166 · see citing works
Clinical Practice Guidelines for the Use of Electroconvulsive Therapy
Thirthalli, J., Sinha, P., & Sreeraj, V. S. (2023) · Indian Journal of Psychiatry · doi:10.4103/indianjpsychiatry.indianjpsychiatry_491_22 · Cited by 74 · see citing works
- Authors
- Radman, T., & Lisanby, S. H.
- Affiliations
- National Institute of Mental Health (US)
- Corresponding author
- Lisanby, Sarah H.
- ORCID
- Lisanby, Sarah H.
- Venue
- International Review of Psychiatry
- Publisher
- Informa UK Limited
- Published
- 2017-03-04
- Volume
- 29
- Issue
- 2
- Pages
- 63-78
- ISSN
- 0954-0261 (ISSN-L)
- 1369-1627
- OpenAlex
- W2605859842
- Cited by
- 14
- References
- 9
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 2 · 2020: 1 · 2019: 1 · 2018: 4 · 2017: 2
- FWCI
- 0.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Review of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Keywords
- magnetic seizure therapy, electroconvulsive therapy, stimulation focality, hippocampal sparing, cognitive side effects, electric field simulation, neural modeling, depression treatment, current spread
- MeSH terms
- Mental Disorders, Convulsive Therapy, Humans, Magnetic Field Therapy
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