title: Transcranial direct current stimulation improves seizure control in patients with Rasmussen encephalitis.
abstract: Rasmussen encephalitis is associated with severe seizures that are unresponsive to antiepileptic drugs, as well as immunosuppressants. Transcranial direct current stimulation (t-DCS) is a non-invasive and safe method tried mostly for focal epilepsies with different aetiologies. To date, there is only one published study with two case reports describing the effect of t-DCS in Rasmussen encephalitis. Our aim was to investigate the effect of t-DCS on seizures in Rasmussen encephalitis and to clarify its safety. Five patients (mean age: 19; three females), diagnosed with Rasmussen encephalitis were included in this study. Patients received first cathodal, then anodal (2 mA for 30 minutes on three consecutive days for non-sham stimulations), and finally sham stimulation with two-month intervals, respectively. Three patients received classic (DC) cathodal t-DCS whereas two patients received cathodal stimulation with amplitude modulation at 12 Hz. Afterwards, all patients received anodal stimulation with amplitude modulation at 12 Hz. In the last part of the trial, sham stimulation (a 60-second stimulation with gradually decreasing amplitude to zero in the last 15 seconds) was applied to three patients. Maximum current density was 571 mA/m2 using 70 mm x 50 mm wet sponge electrodes with 2-mA maximum, current controlled stimulator, and maximum charge density was 1028 C/m2 for a 30-minute stimulation period. After cathodal stimulation, all but one patient had a greater than 50% decrease in seizure frequency. Two patients who received modulated cathodal t-DCS had better results. The longest positive effect lasted for one month. A second trial with modulated anodal stimulation and a third with sham stimulation were not effective. No adverse effect was reported with all types of stimulations. Both classic and modulated cathodal t-DCS may be suitable alternative methods for improving seizure outcome in Rasmussen encephalitis patients.
authors: Department of Neurology, Istanbul Faculty of Medicine, Istanbul University.
authors: Pinar
authors: P
authors: Tekturk
authors: Department of Physiology, Istanbul Bilim University.
authors: Ezgi Tuna
authors: ET
authors: Erdogan
authors: Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul.
authors: Adnan
authors: A
authors: Kurt
authors: Department of Psychology, Centre for Speech, Language and the Brain, University of Cambridge, Cambridge, UK.
authors: Ece
authors: E
authors: Kocagoncu
authors: Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul.
authors: Zeynep
authors: Z
authors: Kucuk
authors: Department of Neurology, Okmeydani Education and Research Hospital, Istanbul, Turkey.
authors: Demet
authors: D
authors: Kinay
authors: Department of Neurology, Istanbul Faculty of Medicine, Istanbul University.
authors: Zuhal
authors: Z
authors: Yapici
authors: Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul.
authors: Serkan
authors: S
authors: Aksu
authors: Department of Neurology, Istanbul Faculty of Medicine, Istanbul University.
authors: Betul
authors: B
authors: Baykan
authors: Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul.
authors: Sacit
authors: S
authors: Karamursel
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D004660:Encephalitis / Q000628:therapy*; D004828:Epilepsies, Partial / Q000628:therapy*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000628:therapy*; D008297:Male; D009044:Motor Cortex; D012640:Seizures / Q000628:therapy*; D065908:Transcranial Direct Current Stimulation / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Rasmussen encephalitis; direct current stimulation; epilepsy