ECT vs Ketamine: NEJM Article Sets Up False Equivalency

Out on PubMed today is this letter-to-the-editor  in Clinical Neurophysiology from researchers at Columbia University:

Smaller increase in delta post-ictal suppression in magnetic seizure therapy than electroconvulsivetherapy in geriatric patients with severe depression: A multi-case study.

Rowny SB, Kluisza L, Prudic J, Ly MT, Chen CM, Casal-Roscum L.

Clin Neurophysiol. 2020 Mar 12;131(6):1219-1220. doi: 10.1016/j.clinph.2020.03.001. [Epub ahead of print] No abstract available. 

PMID:

32299005

The pdf is here.

This is a post-hoc analysis of EEG data from 6 patients (3 MST, 3 RUL-UBP ECT), with clinical vignettes to demonstrate the antidepressant efficacy of MST with a favorable side-effect profile.
The EEG findings included:"Specifically, MST responders showed smaller or no increases from start to end of treatment in delta post-ictal suppression, while ECT responders showed greater increases in delta post-ictal suppression."

That MST and ECT should have different EEG signatures, both ictal and interictally should not be a surprise. Correlating EEG changes with clinical response has been a focus of ECT research for many decades. It remains to be seen if MST can match the clinical efficacy of ECT, with fewer acute side effects, and less profound (or maybe just different) effects on EEG. It should also be noted that the ECT in this study was right unilateral ultra brief pulse, a form of ECT that likely results in less profound EEG changes than other techniques.
MST is a very interesting experimental variant of ECT-we will have to wait and see if it develops into a viable clinical treatment in the future.