Repetitive transcranial magnetic stimulation decreases the number of seizures in patients with focal neocortical epilepsy

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 0.5 Hz 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 +/- 8.3 events/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 0.5 Hz 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. (C) 2008 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.