Abstracts

Rationale: Around 20-40% of patients with epilepsy are not controlled by drugs or surgery. These patients are very difficult to manage; they consume substantial health resources, usually have major disabilities and social disadvantage, and have a high risk of death. Repetitive transcranial magnetic stimulation is a neuromodulatory technique that can be used to stimulate the brain with the aim to reduce the frequency and/or severity of seizures. Methods: We have studied four patients with severely refractory epilepsy: two adult patients with epilepsia partialis continua (primary motor and primary sensory cortices) and two with frequent daily seizures (supplementary motor and lateral temporal cortices). The stimulated area was the one considered as the most likely epileptogenic cortex. The rTMS protocol consisted in four trials of 250 pulses at 120% motor threshold and 0.5Hz with a round coil. In two patients, a second trial was tried the following day with a figure of 8 coil. Electroencephalograms were recorded for an hour before, during and after an hour’s repetitive transcranial magnetic stimulation. These were analysed for the frequency of seizures, myoclonic jerks and epileptiform discharges using Advanced Source analysis 4 software and visual inspection. Results: 3 out of 4 patients showed a significant reduction in epileptiform discharges or in frequency and severity of seizures immediately after rTMS with a round coil, lasting for 7-14 days. In the two cases with EPC, a clear improvement was noted immediately after the first trial. As a result of this technique one of the patients with EPC was implanted with an intracranial chronic cortical stimulation device (EPC resolved), two patients are considered for chronic rTMS as a potential treatment. Conclusions: The initial results give a good indication that this technique could be particularly useful in patients with epilepsia partialis continua. However, more research in this subject is necessary to analysed if rTMS could have neuromodulatory effects on the epileptogenic cortex. Funding: None