title: Antiepileptic effects of low frequency repetitive transcranial magnetic stimulation: A meta-analysis.
abstract: OBJECTIVE
  To evaluate the antiepileptic efficacy of low frequency repetitive transcranial magnetic stimulation (rTMS) in medically intractable epilepsy.
  
  
  METHODS
  A comprehensive literature search was performed on articles published from 1990 to 2010 in Medline, Pubmed, CINAHL, and Cochrane using the following keywords: epilepsy, seizure, transcranial magnetic stimulation, repetitive transcranial magnetic stimulation. Two reviewers assessed article eligibility and extracted the data independently. For outcome measures, effect size and 95% confidence interval (CI) were calculated for seizure frequency, spike number, duration of epileptiform abnormalities (EAs), and resting motor threshold (RMT) by using fixed and random effect models.
  
  
  RESULTS
  Eleven articles were identified, with a total of 164 participants. Based on seizure frequency, a significant effect size was found (effect size: 0.34, with a 95% CI at 0.10-0.57). Considering between-study heterogeneity, we conducted a second meta-analysis, and the underlying etiology was considered important for the treatment effect. Cortical dysplasia or neocortical epilepsy showed an effect size of 0.71, with a 95% CI at 0.30-1.12. In contrast, other epileptic disorders showed an effect size of 0.22.
  
  
  CONCLUSIONS
  Low frequency rTMS has a favorable effect on seizure reduction, particularly evident in patients with neocortical epilepsy or cortical dysplasia.
authors.affiliation: Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Laboratory of Neurophysiology, Taipei Veterans General Hospital, Taipei, Taiwan; Integrated Brain Research Laboratory, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Wan-Yu
authors.initials: WY
authors.lastname: Hsu
authors.forename: Chia-Hsiung
authors.initials: CH
authors.lastname: Cheng
authors.forename: Ming-Wei
authors.initials: MW
authors.lastname: Lin
authors.forename: Yang-Hsin
authors.initials: YH
authors.lastname: Shih
authors.forename: Kwong-Kum
authors.initials: KK
authors.lastname: Liao
authors.forename: Yung-Yang
authors.initials: YY
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004827:Epilepsy / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D054220:Malformations of Cortical Development / Q000150:complications / Q000503:physiopathology*; D008875:Middle Aged; D019579:Neocortex / Q000503:physiopathology*; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome; D055815:Young Adult