Rotenberg Alexander, Bae Erica Hyunji, Takeoka Masanori, Tormos Jose M, Schachter Steven C, Pascual-Leone Alvaro
Department of Neurology, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Epilepsy Behav. 2009 Jan;14(1):253-7. doi: 10.1016/j.yebeh.2008.09.007. Epub 2008 Oct 30.
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.
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.
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.
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.
重复经颅磁刺激（rTMS）是一种用于非侵入性局灶性脑刺激的技术，通过波动的颅外磁场产生小的颅内电流。在临床癫痫中，rTMS最常用于发作间期以降低癫痫发作频率。较少情况下，rTMS已被用于终止正在进行的癫痫发作，如在持续性部分性癫痫（EPC）病例中。发作期rTMS治疗EPC是否有效和安全尚未得到广泛研究。在此，我们描述了我们最近使用rTMS治疗EPC的经验，作为评估rTMS治疗顽固性进行性局灶性癫痫发作安全性和有效性的早期步骤。
7例病因混合的EPC患者接受了在癫痫发作部位进行的rTMS治疗。rTMS以高频（20 - 100Hz）脉冲串或延长的低频（1Hz）序列进行。7例患者中有3例记录了脑电图。
rTMS使7例患者中的3例癫痫发作短暂（20 - 30分钟）停止，7例中的2例癫痫发作持续（≥1天）停止。文献检索发现另外6篇关于rTMS治疗EPC的报告，其中6例中有3例癫痫发作得到抑制。rTMS在任何患者中均未加重癫痫发作。一般轻微的副作用包括短暂的头部和肢体疼痛，以及高频rTMS序列期间的肢体僵硬。
我们在少数患者中的临床观察表明，rTMS在抑制与EPC相关的正在进行的癫痫发作方面可能是安全有效的。然而，需要进行对照试验来评估rTMS治疗EPC的安全性和抗惊厥疗效。
