title: The effect of transcranial direct current stimulation on seizure frequency of patients with mesial temporal lobe epilepsy with hippocampal sclerosis.
abstract: OBJECTIVE
  Transcranial direct current stimulation (tDCS) is a non-invasive and safe method tried in drug-resistant epilepsies, in recent years. Our aim was to evaluate the effect of tDCS in patients diagnosed with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) which is a well-known drug-resistant focal epilepsy syndrome.
  
  
  METHODS
  Twelve MTLE-HS patients diagnosed with their typical clinical, EEG and MRI findings fulfilling the criteria for drug-resistance as suggested by the ILAE commission were included after Ethics Committee approval and their signed consent. All patients received modulated cathodal stimulation; 2mA for 30min on 3 consecutive days. All patients also received sham stimulation with the same electrode positions; designed as 60s stimulation gradually decreasing in 15s with placement of the electrodes for 30min over the stimulation side. They were followed up by standard seizure diaries and their medical treatment was not changed during the study period. Their seizure frequencies both before and after cathodal tDCS and sham stimulation were compared statistically. Adverse effects were also questioned.
  
  
  RESULTS
  Mean age of our study group was 35.42±6.96 (6 males; median: 35.50). The mean seizure frequency was 10.58±9.91 (median=8; min-max=2-30) at the baseline and significantly decreased to 1.67±2.50 (median=0.5; min-max=0-8) after cathodal tDCS application (p=0.003). Ten patients (83.33%) had more than 50% decrease in their seizure frequencies after cathodal tDCS. Two patients (16.67%) also showed positive sham effect. Six patients (50%) were seizure-free in the post-cathodal tDCS period of one month. No adverse effect has been reported except tingling sensation during cathodal stimulation.
  
  
  CONCLUSIONS
  Our small series suggested that cathodal tDCS may be used as an additional treatment option in MTLE-HS. It may be tried in TLE-HS patients waiting for or rejecting epilepsy surgery or even with ineffective surgery results. More studies are needed with large series of patients to investigate the effects of tDCS in drug resistant epilepsies.
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Turkey. Electronic address: pinartopaloglu2000@yahoo.com.
authors.forename: Pinar
authors.initials: P
authors.lastname: Tekturk
authors.affiliation: Istanbul Bilim University Faculty of Medicine, Department of Physiology, Turkey; Istanbul University, Istanbul Faculty of Medicine, Department of Physiology, Matter and Mind Interactions Laboratory, Turkey.
authors.forename: Ezgi Tuna
authors.initials: ET
authors.lastname: Erdogan
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Physiology, Matter and Mind Interactions Laboratory, Turkey.
authors.forename: Adnan
authors.initials: A
authors.lastname: Kurt
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Turkey; Koc University School of Medicine, Department of Neurology, Turkey.
authors.forename: Ebru Nur
authors.initials: EN
authors.lastname: Vanli-Yavuz
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Turkey.
authors.forename: Esme
authors.initials: E
authors.lastname: Ekizoglu
authors.affiliation: University of Cambridge, Centre for Speech, Language and the Brain, Department of Psychology, United Kingdom.
authors.forename: Ece
authors.initials: E
authors.lastname: Kocagoncu
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Physiology, Matter and Mind Interactions Laboratory, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Kucuk
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Physiology, Matter and Mind Interactions Laboratory, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Aksu
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Turkey.
authors.forename: Nerses
authors.initials: N
authors.lastname: Bebek
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Turkey.
authors.forename: Zuhal
authors.initials: Z
authors.lastname: Yapici
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Turkey.
authors.forename: Candan
authors.initials: C
authors.lastname: Gurses
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Turkey.
authors.forename: Aysen
authors.initials: A
authors.lastname: Gokyigit
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Turkey.
authors.forename: Betul
authors.initials: B
authors.lastname: Baykan
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Physiology, Matter and Mind Interactions Laboratory, Turkey.
authors.forename: Sacit
authors.initials: S
authors.lastname: Karamursel
mesh_terms: D000328:Adult; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000628:therapy*; D005260:Female; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D012598:Sclerosis / Q000473:pathology; D065908:Transcranial Direct Current Stimulation / Q000379:methods*
keywords: Cathodal tDCS; Drug resistant epilepsy; Hippocampal sclerosis; Modulated tDCS; Temporal lobe epilepsy; Transcranial direct current stimulation (tDCS)