Blog # 174: Transcranial Magnetic Stimulation for Drug-Resistant Epilepsy

 

Susan Fitzgerald summarized this study in the January 2, 2025, issue of Neurology Today. Transcranial Magnetic Stimulation (TMS) is a non-invasive neurotherapeutic procedure using magnetic fields from coils placed over the head to stimulate specific areas of the brain. Safe and painless, it has been used for chronic pain, migraine and various mental health conditions as depression, obsessive=compulsive disorder, etc. TMS is being investigated for other conditions including movement disorders, neuropathic pain and stroke.

 

A Chinese study of patients aged 18-65 diagnosed with drug-resistant epilepsy (DRE) found that sessions of continuous transcranial magnetic stimulation (TMS) targeting the cerebellum (in the back of the brain, hitherto not usually believed to play a major role in epileptic seizures but has been considered for several decades) may reduce seizure frequency in patients whose anticonvulsant medications fail to control their seizures. Thirty-eight patients were randomized to receive active stimulation followed by sham stimulation. The frequency positive responder-rate increased by 24% compared with sham stimulation. Some patients became seizure-free during the entire two months of the study. The exact mechanism how these results were achieved, and which type of epilepsy are more likely to benefit, are unknown.¹

 

Of the 38 studied patients, 31 had focal epilepsy, one had generalized epilepsy and six had uncertain onset. Each patient had a total of 10 TMS sessions. The sham patients then switched to the active TMS arm of the study. Both sides of the cerebellum (the dentate nucleus) were targeted but are there other nearby structures affected? Participants studied had a 34% reduction in seizures following active treatment and 23% reduction in seizures following sham treatments. Adverse reactions included headache, tinnitus (ringing in the ears) and dizziness. All these problems resolve within days.

 

One consideration in interpretating the result is that “blinding” the study population is problematical as actual stimulation feels nothing like the sham stimulation.

 

Large-sample, multicenter, randomized controlled trials are needed to further validate the efficacy but if further research confirms the efficacy and safety of TMS, it’s an easy and inexpensive treatment. A new treatment option for poorly controlled epilepsy that doesn’t involve surgery or more medications should appeal to patients.

 

I describe another research to control epilepsy that can give hope to our patients that they are not alone.

1.     Wang YY, Ma L, Shi X-J, et al. Cerebellar transcranial magnetic stimulation to treat drug-resistant epilepsy: A randomized, controlled, crossover clinical trial. Epilepsia 2024; Vol 66, Issue 1: p240-252. https://doi.org/10.1111/epi.1816

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.