Islam Karimul, Starnes Keith, Smith Kelsey M, Richner Thomas, Gregg Nicholas, Rabinstein Alejandro A, Worrell Gregory A, Lundstrom Brian N
Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Child and Adolescent Neurology, Mayo Clinic, Rochester, Minnesota, USA.
Epilepsia Open. 2025 Apr 10. doi: 10.1002/epi4.70033.
Noninvasive brain stimulation (NIBS) provides a treatment option for patients not eligible for surgical intervention or who seek low-risk approaches and may be used in the hospital, clinic, and at home. Our objective is to summarize our single-center experience with multiple NIBS approaches for the treatment of focal epilepsy.
A retrospective chart review identified drug-resistant focal epilepsy patients who received NIBS as an epilepsy treatment at Mayo Clinic in Rochester, MN. Patients were typically treated as follows: (1) for TMS, 1 Hz stimulation was applied for five consecutive days in the neuromodulation clinic, (2) for outpatient tDCS, stimulation was applied for five consecutive days in the clinic, followed by optional treatment at home, and (3) for inpatient tDCS, stimulation was applied for three consecutive days. We analyzed continuous EEG data for the inpatient tDCS cohort and available HD-EEG data for outpatient cohorts to quantify changes in interictal epileptiform discharges (IEDs) as a result of stimulation. Outcomes were assessed at 1 month for TMS and outpatient tDCS and 1 week for inpatient tDCS.
Twenty-four patients were treated with TMS (n = 10) and tDCS (n = 14, 9 as outpatients). The median age was 40 years (range 15-73). The median seizure reduction following stimulation was 50%. Fourteen patients (58%) were responders to treatment (TMS = 4/10, tDCS Outpatient = 7/9, tDCS Inpatient = 3/5). Five outpatient tDCS participants elected to continue treatment at home. Four TMS and four outpatient tDCS patients underwent high-density EEG before and after 5 days of therapy. Following stimulation, IED rate was reduced in 4/5 inpatient tDCS patients, 4/4 outpatient tDCS patients, and 4/4 TMS patients. Two patients experienced an increase in seizure frequency (1 following TMS and 1 following outpatient tDCS), which returned to baseline 4-6 weeks after stimulation treatments were discontinued.
TMS and tDCS are potential treatment approaches for drug-resistant focal epilepsy patients in the hospital, clinic, and home. They have a favorable safety profile and can lead to a reduction in IED rates and seizures. These results suggest further studies are needed to examine NIBS as a treatment for epilepsy.
Noninvasive brain stimulation, such as transcranial magnetic stimulation and transcranial direct current stimulation, offers new treatment options for patients with focal seizures. This study reviewed the experience at Mayo Clinic using noninvasive brain stimulation in the hospital, clinic, and at-home settings to treat seizures. The results showed an overall 50% median seizure reduction, and 58% of patients had at least a 50% reduction in seizures. Noninvasive brain stimulation is a promising treatment approach with a favorable safety profile.
无创脑刺激（NIBS）为不符合手术干预条件或寻求低风险治疗方法的患者提供了一种治疗选择，可在医院、诊所和家中使用。我们的目的是总结我们单中心采用多种NIBS方法治疗局灶性癫痫的经验。
通过回顾性病历审查，确定在明尼苏达州罗切斯特市梅奥诊所接受NIBS作为癫痫治疗的耐药局灶性癫痫患者。患者通常接受以下治疗：（1）对于重复经颅磁刺激（TMS），在神经调节诊所连续5天施加1赫兹刺激；（2）对于门诊经颅直流电刺激（tDCS），在诊所连续5天施加刺激，随后可选择在家中继续治疗；（3）对于住院患者tDCS，连续3天施加刺激。我们分析了住院患者tDCS队列的连续脑电图数据和门诊队列可用的高密度脑电图（HD-EEG）数据，以量化刺激导致的发作间期癫痫样放电（IED）的变化。在TMS和门诊tDCS治疗1个月时以及住院tDCS治疗1周时评估结果。
24例患者接受了TMS（n = 10）和tDCS治疗（n = 14，9例为门诊患者）。中位年龄为40岁（范围15 - 73岁）。刺激后癫痫发作减少的中位数为50%。14例患者（58%）对治疗有反应（TMS = 4/10，门诊tDCS = 7/9，住院tDCS = 3/5）。5例门诊tDCS参与者选择在家中继续治疗。4例TMS患者和4例门诊tDCS患者在治疗5天前后接受了高密度脑电图检查。刺激后，4/5住院tDCS患者、4/4门诊tDCS患者和4/4 TMS患者的IED率降低。2例患者癫痫发作频率增加（1例在TMS治疗后，1例在门诊tDCS治疗后），在停止刺激治疗4 - 6周后恢复到基线水平。
TMS和tDCS是医院、诊所和家庭中耐药局灶性癫痫患者的潜在治疗方法。它们具有良好的安全性，可导致IED率和癫痫发作减少。这些结果表明需要进一步研究以检验NIBS作为癫痫治疗方法的效果。
无创脑刺激，如经颅磁刺激和经颅直流电刺激，为局灶性癫痫患者提供了新的治疗选择。本研究回顾了梅奥诊所在医院、诊所和家庭环境中使用无创脑刺激治疗癫痫的经验。结果显示癫痫发作减少的中位数总体为50%，58%的患者癫痫发作至少减少50%。无创脑刺激是一种有前景的治疗方法，具有良好的安全性。
