Abstract
Transcranial magnetic stimulation (TMS) is based on the extracranial application of strong magnetic fields that penetrate the skull in a non-invasive manner and result in cortical activation (excitation and inhibition depending on the stimulation frequencies) of the principal output neurons of the human cortex, mainly the pyramidal cells. Due to its ability to modulate brain functions, TMS shows significant potential for treating neurological and psychiatric disorders, including seizure disorders, both focal and generalized. It is a safe and easy to perform procedure that can give insight into the pathophysiological substrate of seizure disorders with diagnostic, prognostic and therapeutic potential. Applications in patients with epilepsy include investigation of underlying cortical excitability regions, and determination of the effects of antiepileptic drugs (AEDs), preoperative localization of epileptic foci, and functional mapping of eloquent areas. Particularly, navigated TMS (nTMS), where the stimulation selectively activates brain regions to identify a motor, sensory or language response has become an important part of epilepsy surgery evaluation in some medical centers. The therapeutic value of TMS in epilepsy is discordant among different multicenter studies; further clinical testing of this rapidly evolving technology is needed.
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