Slow repetitive TMS for drug-resistant epilepsy: clinical and EEG findings of a placebo-controlled trial.
OBJECTIVE
To assess the effectiveness of slow repetitive transcranial magnetic stimulation (rTMS) as an adjunctive treatment for drug-resistant epilepsy.


METHODS
Forty-three patients with drug-resistant epilepsy from eight Italian Centers underwent a randomized, double-blind, sham-controlled, crossover study on the clinical and EEG effects of slow rTMS. The stimulus frequency was 0.3 Hz. One thousand stimuli per day were given at the resting motor threshold intensity for 5 consecutive days, with a round coil at the vertex.


RESULTS
"Active" rTMS was no better than placebo for seizure reduction. However, it decreased interictal EEG epileptiform abnormalities significantly (p < 0.05) in one-third of the patients, which supports a detectable biologic effect. No correlation linked the rTMS effects on seizure frequency to syndrome or anatomic classification, seizure type, EEG changes, or resting motor threshold (an index of motor cortex excitability).


CONCLUSIONS
Although the antiepileptic action was not significant (p > 0.05), the individual EEG reactivity to "active" rTMS may be encouraging for the development of more-powerful, noninvasive neuromodulatory strategies.
Cantello
Roberto
R
Department of Clinical and Experimental Medicine, Section of Neurology, Amedeo Avogadro University, Novara, Italy. cantello@med.unipmn.it
Rossi
Simone
S
Varrasi
Claudia
C
Ulivelli
Monica
M
Civardi
Carlo
C
Bartalini
Sabina
S
Vatti
Giampaolo
G
Cincotta
Massimo
M
Borgheresi
Alessandra
A
Zaccara
Gaetano
G
Quartarone
Angelo
A
Crupi
Domenica
D
Laganà
Angela
A
Inghilleri
Maurizio
M
Giallonardo
Anna Teresa
AT
Berardelli
Alfredo
A
Pacifici
Loredana
L
Ferreri
Florinda
F
Tombini
Mario
M
Gilio
Francesca
F
Quarato
Pierpaolo
P
Conte
Antonella
A
Manganotti
Paolo
P
Bongiovanni
Liugi Giuseppe
LG
Monaco
Francesco
F
Ferrante
Daniela
D
Rossini
Paolo Maria
PM
D000328:Adult; D015331:Cohort Studies; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004351:Drug Resistance; D004569:Electroencephalography / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D019579:Neocortex / Q000503:physiopathology; D010919:Placebos; D018401:Sample Size; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
D010919:Placebos