Authors :
Presenting Author: Shujuan Tian, MD – 河北医科大学第一医院
Yuan Xing, MD – 河北医科大学第一医院
Yuteng Sun, MD – 河北医科大学第一医院
Junping Jiao, MD – 河北医科大学第一医院
Chao Gao, MD – 河北医科大学第一医院
Rationale:
The therapeutic approach combining transcranial electrical stimulation (tES) with repetitive transcranial magnetic stimulation (rTMS) has been proven effective in various neurological diseases. However, there are currently no studies or reports on the use of this combined treatment for refractory epilepsy. To initially explore whether this combined stimulation method is also effective for refractory epilepsy.
Methods:
we innovatively applied oscillatory transcranial direct current stimulation (otDCS) together with rTMS to a 10-year-old child diagnosed with refractory epilepsy and developmental delays in cognitive and language functions. The cathode for electrical stimulation and the coil for magnetic stimulation were both positioned on the scalp surface corresponding to the patient's epileptic focus origin area. The anode was placed near Fp1, where it had the least impact on the epileptic focus during stimulation. The current intensity was 2 mA, with a frequency of 1 Hz for oscillating direct current stimulation. The stimulation lasted for 20 minutes, which constituted one session. After a 20-minute interval, thesame treatment session was repeated. The output intensity of magnetic stimulation was set at 90% of the resting motor threshold (rMT), with a frequency of 1 Hz. One sequence consisted of 1200 stimuli, and after a 20-minute interval, the second identical treatment sequence was repeated. After continuous stimulation for 5 days, there was a 2-day break before starting the next week of stimulation. The total duration of the treatment course was 21 days We recorded the changes in seizure frequency before and after the treatment and followed up with the patient for a period of 8 weeks. We used the Boston Naming Test to assess subjects' language naming ability before and after stimulation. We also analyzed electroencephalogram data to examine functional connectivity differences and calculated graph theory metrics.
Results:
After the stimulation, the child's seizure frequency significantly decreased during the 8-week follow-up period. The child's score on the Boston Naming Test increased from 10 points before the stimulation to 16 points after the stimulation.The EEG functional connectivity analysis showed that the functional connections between certain brain regions in the frontal and temporal lobes were significantly enhanced after the stimulation. The graph theory analysis indicated an increase in both local and global efficiency compared to before the stimulation.
Conclusions:
Through the preliminary exploration of this study, we found that the combination of otDCS and rTMS stimulation have therapeutic effects on patients with refractory epilepsy and can modulate the abnormal brain functional networks in epilepsy patient. This combined treatment strategy offers a new approach for adjunctive interventions in refractory epilepsy.
Funding:
the National Key Research and Development Program of China (2022YFC3600500,2022YFC3600503)