Exploring the impact of cognitive profiles on the response to magnetic seizure therapy and electroconvulsive therapy

Magnetic seizure therapy (MST) and electroconvulsive therapy (ECT) are effective treatments for schizophrenia (SCZ) and major depressive disorder (MDD), with MST offering advantages in preserving cognitive function. Although cognitive profiles are known to influence treatment outcomes, their role in moderating response to seizure therapies remains unclear. We conducted an open-label, non-randomized controlled trial to compare the efficacy of MST and ECT across different cognitive profiles. From October 2020 to June 2024, we recruited 263 patients with SCZ and 135 patients with MDD, identifying cognitive profiles through latent profile analysis. Among them, 54 patients with SCZ and 119 patients with MDD received MST or ECT, completing 3 or 4 sessions per week. MST was administered at 100% device output and 100 Hz over the vertex. Treatment effectiveness was measured using the Positive and Negative Syndrome Scale and the 24-item Hamilton Depression Rating Scale, while cognitive function with the MATRICS Consensus Cognitive Battery. We analyzed outcomes trajectories using a linear mixed-effects model. Results indicated significant symptom score reductions for both MST and ECT. MST provided better cognitive benefits, especially in information processing speed. Among cognitive profiles, the Optimal-Cognition Group in SCZ receiving ECT showed the strongest symptom reduction, while the Poor-Cognition Group in MDD receiving ECT exhibited the greatest symptom reduction. In contrast, MST had comparable treatment effects on both cognitive groups in SCZ and MDD. In conclusion, MST and ECT yielded similar clinical outcomes, but MST provided better cognitive protective advantages; baseline cognitive profiles appeared to influence ECT outcomes, whereas MST effects were relatively consistent across cognitive profiles.