The clinical exploration of low ⁃frequency repetitive transcranial magnetic stimulation in refractory epilepsy

Abstract

Objective To observe the effectiveness of low⁃frequency and subthreshold repetitive transcranial magnetic stimulation (rTMS) on patients with refractory epilepsy. Methods Twelve subjects with refractory and focal epilepsy were involved. rTMS as a treatment with 600 pulses, intensity of 90% motor resting threshold and 0.50 Hz frequency was administrated once per day, 5 days as one course. Five of twelve patients accepted the second course treatment. The number of seizure frequency, seizure days, and seizure latency at pre ⁃ and pro ⁃ treatment were measured and compared. Meanwhile, the data of electroencephalography (EEG) was collected for calculation. Compared epileptic spike discharges in the EEG and relative power of each frequency distribution (%) by using the software running on MATLAB 7.0. Results rTMS significantly decreased the frequency and days of seizures after 5 days of the first treatment in all 12 patients (t = 2.450, P = 0.032; t = 2.797, P = 0.017), and prolonged seizure latency in 8 patients. Furthermore, high⁃frequency β band relative power distribution showed significant increase (t = ⁃ 2.703, P = 0.021), especially in α band (t = ⁃ 3.680, P = 0.004); while low⁃frequency δ band decreased (t = 3.047, P = 0.011). The amount of EEG sharp waves was reduced significantly (t = 2.411, P = 0.035). Compared with the first course, these indexes were improved in the second treatment. The changes of δ and α bands were great, especially δ band decreased by 2.08 times which suggested that EEG background waves were improved evidently. Conclusion Low ⁃ frequency and subthreshold rTMS can decrease the events of epileptic seizures, prolong seizure latency, and improve epileptic EEG discharges. As a new method in the area of non ⁃ drug ⁃ induced neuro ⁃ modulation, low ⁃ frequency rTMS is a safe and effective treatment for refractory epilepsy. It shows good prospects for clinical application of low ⁃frequency rTMS in refractory epilepsy. DOI：10.3969/j.issn.1672-6731.2010.02.018