Abstracts

Rationale: Transcranial Magnetic stimulation (TMS) is a kind of non-invasive tool and had been used to study neurophysiology since 1985, TMS employed extensively in clinical neurophysiology, is an alternative approach for epilepsy treatment. Reduced seizure frequency has been reported in a small number of patients treated with rTMS (repetitive Transcranial Magnetic Stimulation) at low-frequency stimulus rates. However, all of these studies were short period follow up and variable treatment protocol. To reassess the therapeutic potential of TMS and cortical physiological parameter in patients with epilepsy, we conducted case research of rTMS treatment trial in patient with extremely drug resistant focal onset epilepsy. Methods: Totally 3 intractable right temporal lobe origin epilepsy patients were enrolled in this study, 2 female and 1 male, aged 23 to 44 years old. Study design incorporates 2 months baseline observational period that records seizure frequency and severity of both major and minor seizure attack and other epilepsy profile, Three months Study period that apply 0.5HZ 95% RMT sub-threshold repetitive TMS treatment with 70mm double coil stimulator for 30min each week and measure single pulse cortical silent period (CSP), Resting Motor Threshold (RMT) before and after treatment and finally, 2 months follow up period that record seizure frequency; severity as well. In addition, EEG studies before and just after rTMS treatment course was executed in each patient to evaluate quantities of epileptic discharge. Results: Three impressive findings were revealed in this treatment study; first, all Neurophysiological parameters (magnetic evoked potential) following TMS appear to be absent or ill-defined waveforms; second, reduction of seizure frequency were revealed mainly during study period and up to within first month of follow up period in one case. Third, apparent reduction of epileptiform discharge of EEG study was found in one case, much reduction of spike counts and rhythmic mid-temporal theta activity Conclusions: Motor evoked potential study in epilepsy patients as previous reports, behave attenuated waveform presentation and even further absent in our case series, which is supposed to be caused by the effect of anticonvulsants; multi-pharmacy (3- 4 categories) were prescribed in each patient of our case series. Repetitive TMS (rTMS) treatment in intractable focal temporal lobe epilepsy is of short term benefit effect. Further study including large case series and variable treatment profile of rTMS should be designed and executed to further delineate the role of rTMS in epilepsy treatment.