Fregni Felipe, Otachi Patricia T M, Do Valle Angela, Boggio Paulo S, Thut Gregor, Rigonatti Sergio P, Pascual-Leone Alvaro, Valente Kette D
Center for Non-invasive Brain Stimulation, Beth Israel Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Ann Neurol. 2006 Oct;60(4):447-55. doi: 10.1002/ana.20950.
To study the antiepileptic effects of rTMS in patients with refractory epilepsy and malformations of cortical development in a randomized, double-blind, sham-controlled trial.
Twenty-one patients with malformations of cortical development and refractory epilepsy underwent five consecutive sessions of low-frequency rTMS, either sham or active (1Hz, 1,200 pulses), focally targeting the malformations of cortical development. The number of epileptiform discharges in the electroencephalogram and the number of clinical seizures were measured before (baseline), immediately after, as well as 30 and 60 days after rTMS treatment.
rTMS significantly decreased the number of seizures in the active compared with sham rTMS group (p < 0.0001), and this effect lasted for at least 2 months. Furthermore, there was a significant decrease in the number of epileptiform discharges immediately after (p = 0.01) and at week 4 (p = 0.03) in the active rTMS group only. There were few mild adverse effects equally distributed in both groups. The preliminary cognitive evaluation suggests improvement in some aspects of cognition in the active rTMS group only.
Noninvasive brain stimulation for epilepsy may be an alternative treatment for pharmaco-resistant patients with clearly identifiable seizure foci in the cortical convexity and who are not eligible for surgical treatment.
在一项随机、双盲、假刺激对照试验中，研究重复经颅磁刺激（rTMS）对难治性癫痫和皮质发育畸形患者的抗癫痫作用。
21例皮质发育畸形且患有难治性癫痫的患者连续接受5次低频rTMS治疗，治疗方式为假刺激或真刺激（1赫兹，1200个脉冲），局部针对皮质发育畸形部位。在rTMS治疗前（基线）、治疗后即刻以及治疗后30天和60天，测量脑电图中癫痫样放电的数量以及临床癫痫发作的次数。
与假刺激rTMS组相比，真刺激rTMS组癫痫发作次数显著减少（p < 0.0001），且这种效果持续至少2个月。此外，仅真刺激rTMS组在治疗后即刻（p = 0.01）和第4周（p = 0.03）癫痫样放电数量显著减少。两组均有少量轻度不良反应，且分布均匀。初步认知评估表明，仅真刺激rTMS组在某些认知方面有所改善。
对于皮质凸面有明确可识别癫痫病灶且不适合手术治疗的药物抵抗性癫痫患者，非侵入性脑刺激治疗癫痫可能是一种替代治疗方法。
