Magnetic Seizure Therapy vs Electroconvulsive Therapy in Schizophrenia: Prefrontal-Amygdala Plasticity and Cognitive...

Reducing electroconvulsive therapy (ECT)'s cognitive burden without compromising efficacy is critical. Although magnetic seizure therapy (MST) shows comparable symptom remission in schizophrenia, its neuroanatomical safety-particularly limbic preservation-lacks controlled trial validation.

This triple-blind RCT (NCT02746965) randomized 34 schizophrenia patients to ECT (n=16) or MST (n=18). Structural changes were quantified via 3T MRI (FreeSurfer). Outcomes included Positive and Negative Syndrome Scale (PANSS), Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and generalized linear mixed-effects models with FDR correction (q<0.1).

Both groups achieved comparable PANSS reduction (ECT: Δ=-38.2±5.1 vs MST: Δ=-35.7±6.4, p=0.12). MST showed superior cognitive preservation vs ECT in language (Δ=+7.2 vs ECT: Δ=-3.1; Cohen's d=1.15, p=0.003) and delayed memory (Δ=+5.8 vs +1.2, p=0.04). Nonsignificant between-group differences in amygdala volume changes (ECT: Δ= -1.2% vs -0.9%, p = 0.31).

As the first RCT mapping neuroanatomical changes of convulsive therapies in schizophrenia, we establish MST's cognitive safety via prefrontal-amygdala plasticity-a novel mechanism preserving language and memory functions.