Abstracts

Rationale: Epilepsy is the fourth most common neurological condition with between 20-40% of all patients having drug-resistant epilepsy needing other treatment options. Repetitive transcranial magnetic stimulation and cortical stimulation are neuromodulatory techniques used to stimulate the brain to attempt to reduce the frequency and severity of seizures and epileptiform discharges.

Methods: Two patients underwent low frequency rTMS, using either a round figure or a figure of 8 coil. Up to 1,000 pulses with a stimulation intensity above resting motor threshold in more than 2 different sessions were applied over the seizure onset zone. Three patients had motor focal seizures and 2 patients had epilepsia partialis continua (EPC). Seizure frequency, seizure duration and clinical notes of these patients were retrospectively reviewed. Clinical improvement was determined on a 12-24-hour period before rTMS and compared to a 12-24-hour period after rTMS. This was determined by either seizure frequency or seizure severity. Due to the small sample size of our cohort, a percentage change ≥50% was chosen as the level of a substantial change.

Results: Patient 1 found a significant reduction in epileptiform discharges (p-value < 0.001, 95% CI: 33.870 to 100.446) and number of seizures (p-value=0.003, 95% CI: 7.516 to 12.484) after TMS compared to before TMS but an increase in the number of myoclonic jerks (p-value=0.207, 95% CI: -2737 to1095). Patient 2 found a significant reduction in the number of seizures (p-value=0.049, 95% CI: 0.032 to 9.96) after TMS compared to before TMS but not epileptiform discharges (p-value=0.237, 95% CI: -7.420 to 28.157) or myoclonic jerks (p-value < 0.001, 95% CI: -586.484 to -581.516). Cortical stimulation for both patients reduced their seizure and epileptiform discharge frequency which lead to less frequent jerks and in turn improved hand and arm function in both patients