Repetitive transcranial magnetic stimulation in the treatment of epilepsia partialis continua.
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.
Rotenberg
Alexander
A
Department of Neurology, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA. alexander.rotenberg@childrens.harvard.edu
Bae
Erica Hyunji
EH
Takeoka
Masanori
M
Tormos
Jose M
JM
Schachter
Steven C
SC
Pascual-Leone
Alvaro
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004569:Electroencephalography; D017036:Epilepsia Partialis Continua / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000517:prevention & control; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects; D016896:Treatment Outcome