Use of Transcranial magnetic stimulation to treat drug-resistant epilepsy


Chen R; Spencer DC; Weston J; Nolan SJ. Institution Chen,Ricky. Clinical Neurosciences Center, University of Utah, Department of Neurology, 175 North Medical Drive East, Salt Lake City, Utah, U SA, 84132.


Transcranial magnetic stimulation for the treatment of epilepsy. [Review] Source Cochrane Database of Systematic Reviews. (8)CD011025, 2016 Aug 11.


Epilepsy is a highly prevalent neurological condition characterized by repeated unprovoked seizures with various etiologies. Although antiepileptic medications produce clinical improvement in most individuals, nearly a third of individuals have drug-resistant epilepsy that carries significant morbidity and mortality. There remains a need for non-invasive and more effective therapies for this population. Transcranial magnetic stimulation (TMS) uses electromagnetic coils to excite or inhibit neurons, with repetitive pulses at low-frequency producing an inhibitory effect that could conceivably reduce cortic al excitability associated with epilepsy.


To assess the evidence for the use of TMS in individuals with drug-resistant epilepsy compared with other available treatments in reducing seizure frequency, improving quality of life, reducing epileptiform discharges, antiepileptic medication use, and side-effects.


We searched the Cochrane Epilepsy Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online (CRSO), MEDLINE (Ovid 1946 to 10 March 2016), and the World Health Organization International Clinical Trials Registry Platform (ICTRP) up to March 201 6. We also searched SCOPUS (1823 to June 2014) as a substitute for Embase (but it is no longer necessary to search SCOPUS, because randomized controlled trials (RCTs) and quasi-RCTs in EMBASE are now included in CENTRAL).


Eligible studies were RCTs that were double-bli nded, single-blinded or unblinded, and placebo, no treatment, or active controlled, which used repetitive transcranial magnetic stimulation (rTMS) without restriction of frequency, duration, intensity, or setup (focal o r vertex treatment) on patients with drug-resistant epilepsy. The search revealed 274 records from the databases, that after selection provided seven full-text relevant studies for inclusion. Of the seven studies included, five were completed studies with published data and included randomized, blinded trials. The total number of participants in the sev en trials was 230.


We extracted information from each t rial including methodological data; participant demographics includ ing baseline seizure frequency, type of epileptic drugs taken; intervention details and intervention groups for comparison; potential biases; and outcomes and time points, primarily change in seizure frequency or responder rates, as well as quality of life and epileptiform discharges, adverse effects, and changes in medication use.


Two of the seven studies analyzed showed a statistically significant reduction in seizure rate from baseline (72% and 78.9% reduction of seizures per week from the baseline rate, respectively). The other five studies showed no statistically significant difference in seizure frequency following rTMS treatment compared with controls. We were not able to combine the results of the trials in analysis due to differences in the designs of the studies. Four studies evaluated our secondary endpoint of mean number of epileptic discharges, and three of the four showed a statistically significant reduction in discharges. Quality of life was not assessed in any of the studies. Adverse effects were uncommon among the studies and typically involved headache, dizziness, and tinnitus. No significant changes in medication use we re found in the trials.


Overall, we judged the quality of evidence for t he primary outcomes of this review to be low. There is evidence that rTMS is safe and not associated with any adverse events, but given the variability in technique and outcome reporting that prevented meta-analysis, the evidence for efficacy of rTMS for seizure reduction is still lacking despite reasonable evidence that it is effective at reducing epileptiform


Seynaeve L; Devroye A; Dupont P; Van Paesschen W. Institution Seynaeve,Laura. Department of Neurology, Laboratory for Epilepsy Research, University Hospitals & KU Leuven, Leuven, Belgium. Devroye,Annemie. Department of Neurology, Laboratory for Epilepsy Research, University Hospitals & KU Leuven, Leuven, Belgium. Dupont,Patrick. Department of Neurology, Laboratory for Epilepsy Research, University Hospitals & KU Leuven, Leuven, Belgium. Dupont,Patrick. Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium. Van Paesschen,Wim. Department of Neurology, Laboratory for Epilepsy Research, University Hospitals & KU Leuven, Leuven, Belgium. Title Randomized crossover sham-controlled clinical trial of targeted