The impact of Transcranial Magnetic Stimulation (TMS) on seizure course in people with and without epilepsy

Serena Pang; Sasha D'Ambrosio; Giulia Battaglia; Diego Jiménez-Jiménez; Marco Perulli; Katri Silvennoinen; Sara Zagaglia; Sanjay M Sisodiya; Simona Balestrini

doi:10.1016/j.cnp.2022.05.005

The impact of Transcranial Magnetic Stimulation (TMS) on seizure course in people with and without epilepsy

Clin Neurophysiol Pract. 2022 Jun 13:7:174-182. doi: 10.1016/j.cnp.2022.05.005. eCollection 2022.

Authors

Affiliations

¹ Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, and Epilepsy Society, Chalfont-St-Peter, Bucks, UK.
² School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador.
³ Child Neurology and Psychiatry Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
⁴ Department of Neuroscience, Catholic University Of The Sacred Heart, Rome, Italy.
⁵ Neuroscience Department, Children's Hospital Meyer-University of Florence, Florence, Italy.

Abstract

Objective: To elucidate the effects of single and paired-pulse TMS on seizure activity at electrographic and clinical levels in people with and without epilepsy.

Methods: A cohort of 35 people with epilepsy, two people with alternating hemiplegia of childhood (AHC) with no epilepsy, and 16 healthy individuals underwent single or paired-pulse TMS combined with EEG. Clinical records and subject interviews were used to examine seizure frequency four weeks before and after TMS.

Results: There were no significant differences in seizure frequency in any subject after TMS exposure. There was no occurrence of seizures in healthy individuals, and no worsening of hemiplegic attacks in people with AHC.

Conclusions: No significant changes in seizure activity were found before or after TMS.

Significance: This study adds evidence on the safety of TMS in people with and without epilepsy with follow-up of four weeks after TMS.

Keywords: AHC, Alternating Hemiplegia of Childhood; ASM, Anti-Seizure Medication; Alternating hemiplegia of childhood; CNS, Central Nervous System; E:I Ratio, Excitation: Inhibition Ratio; EEG, Electroencephalography; EMG, Electromyography; EOG, Electrooculography; FDI, First Dorsal Interosseus; HD-EEG, High-Density EEG; ICF, Intracortical Facilitation; LICI, Long Interval Cortical Inhibition; MEP, Motor Evoked Potential; MRI, Magnetic Resonance Imaging; MSO, Maximum Stimulator Output; MT, Motor Threshold; PWE, People with Epilepsy; Paired pulse; QoL, Quality of Life; RMT, Resting Motor Threshold; SCORE, Standardized Computer-based Organized Reporting of EEG; SICI, Short-Interval Intracortical Inhibition; Safety; Single pulse; TEP, TMS-evoked Potential; TMS; TMS, Transcranial Magnetic Stimulation; ppTMS, Paired-pulse TMS; rTMS, Repetitive TMS; spTMS, Single-pulse TMS.