History/Comparison of ECT and rTMS: Review From Italy

 Out on PubMed, from investigators in Italy, is this paper:

One century of healing currents into the brain from the scalp: From electroconvulsive therapy to repetitive transcranial magnetic stimulation for neuropsychiatric disorders.

Di Iorio R, Rossi S, Rossini PM.Clin Neurophysiol. 2021 Nov 11;133:145-151. doi: 10.1016/j.clinph.2021.10.014. Online ahead of print.PMID: 3486451


The abstract is copied below:

Electroconvulsive therapy (ECT) was applied for the first time in humans in 1938: after 80 years, it remains conceptually similar today except for modifications of the original protocol aimed to reduce adverse effects (as persistent memory deficits) without losing clinical efficacy. We illustrate the stages of development as well as ups and downs of ECT use in the last eighty years, and the impact that it still maintains for treatment of certain psychiatric conditions. Targeted, individualized and safe noninvasive neuromodulatory interventions are now possible for many neuropsychiatric disorders thanks to repetitive transcranial magnetic stimulation (rTMS) that injects currents in the brain through electromagnetic induction, powerful enough to depolarize cortical neurons and related networks. Although ECT and rTMS differ in basic concepts, mechanisms, tolerability, side effects and acceptability, and beyond their conceptual remoteness (ECT) or proximity (rTMS) to "precision medicine" approaches, the two brain stimulation techniques may be considered as complementary rather than competing in the current treatment of certain neuropsychiatric disorders.

The pdf is here.

Keywords: Brain stimulation; Depression; ECT; Neuropsychiatric disorders; rTMS.

It is both fitting and ironic that this paper is written by Italians: fitting because ECT was invented there, ironic because almost no ECT is performed in Italy today. The authors seem well-meaning, but IMO end up with a naive, pro-rTMS biased perspective, despite the seemingly balanced view in the sentence highlighted above. If illness severity is ignored, the comparison of ECT and rTMS is moot.
And why do they state that the mechanism of action of ECT is unknown, but imply that the mechanism of action rTMS is quite precisely understood? A double standard, indeed.
The section on the history of ECT is interesting; for that, many ECT practitioners will want to read this article, ~15 minutes.

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