Abstract
Aim of the present study was to evaluate the acute and long-term effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) on focal epileptiform interictal EEG activity in a patient with fixation-off sensitivity and partial epilepsy. Real and sham rTMS were delivered over the vertex. Two trains of 500 stimuli per day were delivered at 0.33 Hz frequency and threshold intensity for five consecutive days. The number of posterior EEG spikes and spike-and-wave complexes/min before and after the application of rTMS were compared in a blinded manner. In our patient, real-rTMS induced a long-lasting decrease in the number of posterior EEG spikes and spike-and-wave complexes/min. Despite the limitations of a single case report, our study confirms that low-frequency rTMS significantly reduces interictal focal epileptic activity over time.
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References
Chen WR, Lee S, Kato K, Spencer DD, Shepherd GM, Williamson A (1996) Long-term modifications of synaptic efficacy in the human inferior and middle-temporal cortex. Proc Natl Acad Sci USA 93:8011–8015
Chen R, Classen J, Gerloff C, Celnik P, Wassermann EM, Hallett M, Cohen LG (1997) Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation. Neurology 48:1398–1403
Cincotta M, Borgheresi A, Gambetti C, Balestrieri F, Rossi L, Zaccara G, Ulivelli M, Rossi S, Civardi C, Cantello R (2003) Subthreshold 0.3 Hz ripetitive TMS prolongs the cortical silent period. Possible implications for therapeutic trials in epilepsy. Clin Neurophysiol 114:1827–1833
Civardi C, Cantello R, Asselman P, Rothwell JC (2001) Transcranial magnetic stimulation can be used to test connections to primary motor areas from frontal and medial cortex in humans. Neuroimage 14:1444–1453
Enomoto H, Ugawa Y, Hanajima R, Yuasa K, Mochizuki H, Terao Y, Shiio Y, Furubayashi T, Iwata I (2001) Decrease sensory cortical excitability after 1 Hz rTMS over ipsilateral primary motor cortex. Clin Neurophysiol 112:2154–2158
Fregni F, Thome-Souza S, Bermpohl F, Marcolin MA, Herzog A, Pascual-Leone A, Valente KD (2005) Antiepileptic effects of repetitive transcranial magnetic stimulation in patients with cortical malformations: an EEG and clinical study. Stereotact Funct Neurosurg 83:57–62
Goyal V, Bhatia M, Behari M (2004) Increased depressant effect of phenytoin sodium as compared to carbamazepine on cortical excitability a transcranial magnetic evaluation. Neurol India 52:224–227
Hamer HM, Reis J, Mueller HH, KnaKe S, Overhof M, Oertel WH, Rosenow F (2005) Motor cortex excitability in focal epilepsies not including the primary motor area-a TMS study. Brain 128:811–818
Hess G, Donoghue JP (1996) Long-term depression of horizontal connections in rat motor cortex. Eur J Neurosci 8:658–665
Inghilleri M, Conte A, Frasca V, Curra’ A, Gilio F, Manfredi M, Berardelli A (2004) Antiepileptic drugs and cortical excitability: a study with repetitive transcranial stimulation. Exp Brain Res 154:488–493
Kinoshita M, Ikeda A, Begum T, Yamamoto J, Hitomi T, Shibasaki H (2005) Low-frequency repetitive transcranial magnetic stimulation for seizure suppression in patients with extratemporal lobe epilepsy—a pilot study. Seizure 14:387–392
Krakow K, Baxendale SA, Maguire EA, Krishnamoorthy ES, Lemieux L, Scott CA, Smith SJ (2000) Fixation-off sensitivity as a model of continuous epileptiform discharges: electroencephalographic, neuropsychological and functional MRI findings. Epilepsy Res 42:1–6
Menkes DL, Gruenthal M (2000) Slow-frequency repetitive transcranial magnetic stimulation in a patient with focal cortical dysplasia. Epilepsia 41:240–242
Misawa S, Kuwabara S, Shibuya K, Mamada K, Hattori T (2005) Low-frequency transcranial magnetic stimulation for epilepsia partialis continua due to cortical dysplasia. J Neurol Sci 234:37–39
Munchau A, Bloem BR, Irlbacher K, Trimble MR, Rothwell JC (2002) Functional connectivity of human premotor and motor cortex explored with repetitive transcranial magnetic stimulation. J Neurosci 22:554–561
Reis J, Wentrup A, Hamer HM, Mueller HH, Knake S, Tergau F, Oertel WH, Rosenow F (2004) Levetiracetam influences human motor cortex excitability mainly by modulation of ion channel function–a TMS study. Epilepsy Res 62:41–51
Romero JR, Anschel D, Sparing R, Gangitano M, Pascual-Leone A (2002) Subthreshold low frequency repetitive transcranial magnetic stimulation selectively decrease facilitation in the motor cortex. Clin Neurophysiol 113:101–107
Rossi S, Ulivelli M, Bartalini S, Galli R, Passero S, Battistini N, Vatti G (2004) Reduction of cortical myoclonus-related epileptic activity following slow-frequency rTMS. A case study. NeuroReport 15:293–296
Tassinari CA, Cincotta M, Zaccara G, Michelucci R (2003) Transcranial magnetic stimulation and epilepsy. Clin Neurophysiol 114:777–798
Tergau F, Naumann U, Paulus W, Steinhoff BJ (1999) Low-frequency repetitive transcranial magnetic stimulation improves intractable epilepsy. Lancet 353:2209
Theodore WH (2003) Transcranial magnetic stimulation in epilepsy. Epilepsy Curr 3:191–197
Theodore WH, Hunter K, Chen R, Vega-Bermudez F, Boroojerdi B, Reeves-Tyer P, Werhahn K, Kelley KR, Cohen L (2002) Transcranial magnetic stimulation for the treatment of seizures: a controlled study. Neurology 59:560–562
Touge T, Gerschlager W, Brown P, Rothwell JC (2001) Are the after-effects of low-frequency rTMS on motor cortex excitability due to changes in the efficacy of cortical synapses? Clin Neurophysiol 112:2138–2145
Tsuji T, Rothwell JC (2002) Long lasting effect of rTMS and associated peripheral sensory input on MEPs, SEPs and transcortical reflex excitability in humans. J Physiol 540:367–376
Turazzini M, Manganotti P, Del Colle R, Silvestri M, Fiaschi A (2004) Serum levels of carbamazepine and cortical excitability by magnetic brain stimulation. Neurol Sci 25:83–90
Wassermann EM, Lisanby SH (2001) Therapeutic application of repetitive transcranial magnetic stimulation: a review. Clin Neurophysiol 112:1367–1377
Ziemann U (2004) TMS and drugs. Clin Neurophysiol 115:1717–1729
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Mecarelli, O., Gregori, B., Gilio, F. et al. Effects of repetitive transcranial magnetic stimulation in a patient with fixation-off sensitivity. Exp Brain Res 173, 180–184 (2006). https://doi.org/10.1007/s00221-006-0577-5
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DOI: https://doi.org/10.1007/s00221-006-0577-5