Magnetic Seizure Therapy for the Treatment of Borderline Personality Disorder
Condition: Borderline Personality Disorder
MeSH terms: Seizures; Personality Disorders; Suicidal Ideation; Borderline Personality Disorder
Study type: Interventional

Summary: 
      Suicide is a major public health crisis for which effective new interventions are needed. An
      innovative new brain stimulation technique called magnetic seizure therapy (MST) shows
      promise for treating suicidal thinking in chronically depressed individuals. Using a
      high-risk cohort of suicidal patients with borderline personality disorder (BPD) and
      treatment resistant major depressive disorder (MDD), this study will evaluate the
      effectiveness of MST for reducing suicidality and depressive symptoms in an open-label
      clinical trial of up to 15 treatment sessions. Based on research showing that functioning of
      the dorsolateral prefrontal cortex (DLPFC) may be disrupted in BPD and place individuals at
      risk for suicide, the DLPFC will be targeted for stimulation. Moderate-to-highly suicidal
      patients with BPD beginning dialectical behavioural therapy (DBT) will be recruited using a
      case-control design, comparing individuals receiving MST and DBT with matched patient control
      group receiving DBT alone.
    

Detailed description: 
      MST is a novel modification of electroconvulsive therapy (ECT) with the potential for similar
      clinical effectiveness, fewer side-effects and a more rapid return of orientation and shorter
      duration of post-ictal confusion. In the proposed study, the investigators will evaluate the
      clinical effectiveness of MST for the treatment of treatment-resistant depression (TRD) and
      suicidal ideation in patients with BPD. The study will use a case-control design comparing
      symptom reports (depression severity and suicidal ideation) and cognitive functioning between
      outpatients receiving MST plus dialectical behavioral therapy (DBT) and matched patient
      controls receiving DBT alone. To evaluate potential biomarkers that may underlie the
      anticipated clinical benefits of MST, functional magnetic resonance imaging (fMRI) will be
      used to measure activation of the DLPFC and associated neural circuits subserving emotion
      regulation and cognitive functioning (e.g., impulse control, episodic memory) in BPD.

      Objective 1: To evaluate the efficacy of MST as a treatment for suicidal ideation and TRD in
      BPD.

      Hypothesis 1: MST will demonstrate substantial efficacy on objective measures of suicidal
      ideation and depression.

      Objective 2: To evaluate the effects of MST on cognitive functioning in patients with BPD.

      Hypothesis 2: MST will have limited, if any, effects on performance on standard
      neuropsychological measures of attention, memory and executive functioning in patients with
      BPD.

      Objective 3: To explore potential neuroimaging-based biomarkers that may index any changes in
      suicidal ideation and depression that result from treatment with MST.

      Hypothesis 3: On neuroimaging tasks assessing emotion processing and cognitive functioning,
      patients receiving DBT+MST will show increased activity in bilateral DLPFC after treatment
      relative to pre-treatment baseline activation, and more activation in this region than
      patients in DBT without concurrent MST (DBT-only).
    

Intervention name(s): MagPro MST with Cool TwinCoil; DBT
Intervention type(s): Device; Behavioral
Intervention description(s): MST treatments will be administered using the MagPro MST with Cool TwinCoil. The investigators will evaluate the effectiveness of MST for reducing suicidality and depressive symptoms in an open-label clinical trial of up to 15 treatment sessions. Moderate-to-highly suicidal patients with BPD beginning dialectical behavioural therapy (DBT) will be recruited using a case-control design, comparing individuals receiving MST and DBT with matched patient control group receiving DBT alone.; Dialectical behavior therapy (DBT) is a specific type of cognitive-behavioral psychotherapy developed to help better treat borderline personality disorder. Moderate-to-highly suicidal patients with BPD beginning dialectical behavioural therapy (DBT) will be recruited using a case-control design, comparing individuals receiving MST and DBT with matched patient control group receiving DBT alone.
Other intervention name(s): Magnetic Seizure Therapy (MST); Dialectical behavior therapy (DBT)
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Using a case-control design, the investigators will compare individuals receiving MST and DBT with matched patient control group receiving DBT alone.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Magnetic seizure therapy (MST); Treatment resistance; Open-label trial; Borderline Personality Disorder; Suicidal Ideation; Treatment-resistant depression; Dialectical behavior therapy (DBT); MST + DBT; Neuroimaging-based biomarkers