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

Jin Li,1,2,* Tingting Jin,1,* Yuyan Chi,1,* Jie Chen,1,* Ju Gao,1 Yong Yang,1 Qing Tian,1 Xiaobin Zhang,1,* Limei Zheng3,* 1Department of Psychiatry, Institute of Mental Health, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China; 2Shanghai Mental Health Center, Shanghai, People’s Republic of China; 3Department of Geriatric Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Limei Zheng, Department of Geriatric Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China, Email [email protected]: 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.Patients and Methods: 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).Results: 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).Conclusion: 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.Plain Language Summary: What we studiedFor severe schizophrenia where medications fail, we compared electroconvulsive therapy (ECT) and magnetic seizure therapy (MST). MST uses magnets instead of electricity and may cause fewer memory issues. This first brain-imaging randomized trial examined: 1. Effects on memory-related brain structures 2. Impacts on thinking skillsHow we studied it 34 participants received ECT (16) or MST (18) for 4 weeks. We measured symptom improvement, memory/language skills and brain changes via MRI.Key findings• Both treatments reduced symptoms equally• MST caused significantly fewer language problems than ECT• Neither treatment changed amygdala sizeWhy it mattersMST works as well as ECT while better protecting language abilities—helping patients communicate during recovery. MST offers a safer alternative that preserves critical thinking.Note: These results from 34 participants need larger trials for confirmation.Keywords: neuromodulation safety, seizure therapy optimization, prefrontal-amygdala axis, therapeutic cognitive index, treatment-resistant psychosis