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Academic Journal
EPILEPSY
| Title: | Transcranial Magnetic Stimulation for Drug-Resistant Epilepsies: Rationale and Clinical Experience. | | Date: | February 11, 2010 | | Author(s): | Kimiskidis VK. | | Source: | Eur Neurol. | | Keywords: |
Drug-resistant epilepsies - Epilepsy - Repetitive transcranial magnetic stimulation - Transcranial magnetic stimulation
| | Abstract: | Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique which, over the last 25 years, has greatly expanded from a simple method for stimulating the motor cortex to an invaluable tool with multiple research, diagnostic and even therapeutic applications. In this review, we discuss the use of repetitive TMS as a means of suppressing cortical hyperexcitability in drug-resistant epilepsies. The theoretical background and the experimental evidence in favor of this novel therapeutic approach are presented, and a number of open-label and controlled studies in patients with various forms of focal epilepsy are reviewed. It is concluded that, although the therapeutic effects of repetitive TMS in epilepsy appear rather limited, further clinical testing of this rapidly evolving technology is warranted. |
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| | Title: | Repetitive transcranial magnetic stimulation in the treatment of epilepsia partialis continua. | | Author(s): | Rotenberg A, Bae EH, Takeoka M, Tormos JM, Schachter SC, Pascual-Leone A. | | Source: | Epilepsy Behav. 2009 Jan;14(1):253-7. Epub 2008 Oct 30. | | Abstract: | OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) is a technique for noninvasive focal brain stimulation by which small intracranial electrical currents are generated by a fluctuating extracranial magnetic field. In clinical epilepsy, rTMS has been applied most often interictally to reduce seizure frequency. Less often, rTMS has been used to terminate ongoing seizures, as in instances of epilepsia partialis continua (EPC). Whether ictal rTMS is effective and safe in the treatment of EPC has not been extensively studied. Here, we describe our recent experience with rTMS in the treatment of EPC, as an early step toward evaluating the safety and efficacy of rTMS in the treatment of intractable ongoing focal seizures. METHODS: Seven patients with EPC of mixed etiologies were treated with rTMS applied over the seizure. rTMS was delivered in high-frequency (20-100 Hz) bursts or as prolonged low-frequency (1 Hz) trains. The EEG was recorded for three of the seven patients. RESULTS: rTMS resulted in a brief (20-30 min) pause in seizures in three of seven patients and a lasting (>or=1 day) pause in two of seven. A literature search identified six additional reports of EPC treated with rTMS where seizures were suppressed in three of six. Seizures were not exacerbated by rTMS in any patient. Generally mild side effects included transient head and limb pain, and limb stiffening during high-frequency rTMS trains. CONCLUSIONS: Our clinical observations in a small number of patients suggest that rTMS may be safe and effective in suppressing ongoing seizures associated with EPC. However, a controlled trial is needed to assess the safety and anticonvulsive efficacy of rTMS in the treatment of EPC |
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| | Title: | Repetitive transcranial magnetic stimulation decreases the number of seizures in patients with focal neocortical epilepsy. | | Author(s): | Santiago-Rodríguez E, Cárdenas-Morales L, Harmony T, Fernández-Bouzas A, Porras-Kattz E, Hernández A. | | Source: | Seizure. 2008 Dec;17(8):677-83. Epub 2008 May 20. | | Abstract: |
PURPOSE: To evaluate the number of seizures and interictal epileptiform discharges (IEDs) in patients with focal neocortical epilepsy before, during and after rTMS. METHODS: Twelve patients (seven men and five women, mean age 29.3+/-15.8 years) were studied. An open-label study with baseline (4 weeks), intervention (2 weeks) and follow-up (8 weeks) periods was carried out. Repetitive transcranial magnetic stimulation (rTMS) with 900 pulses, intensity of 120% motor resting threshold and 0.5Hz frequency was used. A 120 channel EEG was recorded; an electrical source analysis of IEDs with Variable Resolution Electromagnetic Tomography (VARETA) was performed. The number of seizures per week and IEDs per minute were measured and compared in the three periods. RESULTS: During the basal period the mean seizure frequency was 2.25 per week; in the intervention period it decreased to 0.66 per week (F=2.825; p=0.0036) which corresponds to a 71% reduction. In the follow-up period the mean frequency was 1.14 seizures per week, that is, a 50% reduction in the number of seizures. In the visual EEG analysis, the baseline IED frequency was 11.9+/-8.3events/min; it decreased to 9.3+/-7.9 during 2 weeks of rTMS with a further reduction to 8.2+/-6.6 in the follow-up period. These differences however were not significant (p=0.190). CONCLUSION: We conclude that 2 weeks of rTMS at 0.5Hz with a figure-of-eight coil placed over the epileptic focus, determined with VARETA, decreases the number of seizures in patients with focal epilepsy, without reduction in IEDs.
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