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Singh A, Jiménez-Gambín S, Konofagou EE. An all-ultrasound cranial imaging method to establish the relationship between cranial FUS incidence angle and transcranial attenuation in non-human primates in 3D. Sci Rep 2024; 14:1488. [PMID: 38233480 PMCID: PMC10794232 DOI: 10.1038/s41598-024-51623-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024] Open
Abstract
Focused ultrasound (FUS) is a non-invasive and non-ionizing technique which deploys ultrasound waves to induce bio-effects. When paired with acoustically active particles such as microbubbles (MBs), it can open the blood brain barrier (BBB) to facilitate drug delivery otherwise inhibited due to the presence of BBB. One of the parameters that affects the FUS beam propagation is the beam incidence angle on the skull. Prior work by our group has shown that, as incidence angles deviate from 90°, FUS focal pressures attenuate and result in a smaller BBB opening volume. The incidence angles calculated in our prior studies were in 2D and used skull information from CT. The study presented herein develops methods to calculate incidence angle in 3D in non-human primate (NHP) skull fragments using harmonic ultrasound imaging without using ionizing radiation. Our results show that ultrasound harmonic imaging is capable of accurately depicting features such as sutures and eye-sockets of the skull. Furthermore, we were able to reproduce previously reported relationships between the incidence angle and FUS beam attenuation. We also show feasibility of performing ultrasound harmonic imaging in in-vivo non-human primates. The all-ultrasound method presented herein combined with our neuronavigation system stands to increase more widespread adoption of FUS and render it accessible by eliminating the need for CT cranial mapping.
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Affiliation(s)
- Aparna Singh
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | | | - Elisa E Konofagou
- Department of Biomedical Engineering, Columbia University, New York, NY, USA.
- Department of Radiology, Columbia University, New York, NY, USA.
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Gundogdu Celebi L, Sirin NG, Elmali AD, Baykan B, Oge AE, Bebek N. Continuous theta-burst stimulation in patients with drug-resistant epilepsy: A single-blind placebo-controlled cross-over pilot study. Neurophysiol Clin 2023; 53:102896. [PMID: 37657363 DOI: 10.1016/j.neucli.2023.102896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVES To evaluate the effect of continuous theta-burst stimulation (cTBS) in patients with drug-resistant epilepsy (DRE). METHODS Twelve patients with DRE (five with idiopathic generalized and seven with focal epilepsy) were included in this cross-over design study and randomized to either first sham or first active stimulation, each applied for 5 consecutive days. A round coil over the vertex was used in generalized epilepsy or a figure-of-8 coil over the "epileptogenic area" in focal epilepsy. Sham stimulation was given by placing the coil 90° perpendicular to the head. The number of seizures, electroencephalography findings, Quality of Life in Epilepsy Inventory (QOLIE-84), and Symptom Check List (SCL-90) scores evaluated during the 8-12 weeks before and after active and sham stimulations were compared statistically. RESULTS Eight patients could complete both active and sham stimulation periods of 5 days and two patients completed active stimulation sessions, without any significant adverse effects. The number of seizures significantly reduced after active cTBS, but not after sham stimulation, when compared with those recorded before the stimulation period. QOLIE scores were increased, but interictal epileptiform discharges and SCL-90 scores showed no difference after cTBS. Active stimulation was stopped in one patient after he experienced an aggravation of myoclonic seizures. CONCLUSIONS cTBS seemed to be relatively safe and gave promising results in reducing the frequency of seizures in patients with both generalized and focal DRE. This time-saving technique may ease the introduction of repetitive transcranial magnetic stimulation into the routine practice of busy epilepsy clinics.
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Affiliation(s)
- Lale Gundogdu Celebi
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nermin Gorkem Sirin
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Ayse Deniz Elmali
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Betul Baykan
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Emre Oge
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nerses Bebek
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Dong L, Song LL, Zhao WJ, Zhao L, Tian L, Zheng Y. Modulatory effects of real-time electromagnetic stimulation on epileptiform activity in juvenile rat hippocampus based on multi-electrode array recordings. Brain Res Bull 2023; 198:27-35. [PMID: 37084982 DOI: 10.1016/j.brainresbull.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/10/2023] [Accepted: 04/18/2023] [Indexed: 04/23/2023]
Abstract
Electromagnetic stimulation (EMS) has proven to be useful for the focal suppression of epileptiform activity (EFA) in the hippocampus. There is a critical period during EFA for achieving the transition from brief interictal discharges (IIDs) to prolonged ictal discharges (IDs), and it is unknown whether EMS can modulate this transition. Therefore, this study aimed to evaluate the intensity- and time-dependent effect of EMS on the transition of EFA. A juvenile rat EFA model was constructed by perfusing magnesium-free artificial cerebrospinal fluid (aCSF) on brain slices, and the induced EFA was recorded using a micro-electrode array (MEA) platform. After a stable EFA event was recorded for some time, real-time pulsed magnetic stimulation with low and high peak-to-peak input magnetic field intensities was carried out. A 5-min intervention with real-time magnetic fields with low intensity was found to reduce the amplitude of IDs (ID events still existed), whereas a 5-min intervention with real-time magnetic fields with high input voltages completely suppressed IDs. Short-time magnetic fields (9s and 1min) with high or low input intensity had no effect on EFA. Real-time magnetic fields can block the normal EFA process from IIDs to IDs (i.e., a complete EFA cycle) and this suppression effect is dependent on input intensities and intervention duration. The experimental findings further indicate that magnetic stimulation may be chosen as an alternative antiepileptic therapy.
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Affiliation(s)
- Lei Dong
- School of Life Sciences, Tiangong University, Tianjin 300387, China; State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin University, Tianjin 300072, China
| | - Lin-Lin Song
- School of Life Sciences, Tiangong University, Tianjin 300387, China; School of Electronic and Information Engineering, Tiangong University, Tianjin 300387, China
| | - Wen-Jun Zhao
- School of Life Sciences, Tiangong University, Tianjin 300387, China
| | - Ling Zhao
- School of Life Sciences, Tiangong University, Tianjin 300387, China
| | - Lei Tian
- School of Life Sciences, Tiangong University, Tianjin 300387, China
| | - Yu Zheng
- School of Life Sciences, Tiangong University, Tianjin 300387, China.
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Zhidik AG, Kozhokaru AB. [Alternative methods of therapy for comorbid sleep disorders as a method of choice in adult patients with epilepsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:42-48. [PMID: 37655409 DOI: 10.17116/jnevro202312308142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Systematization and generalization of data from domestic and foreign literature on alternative methods of treatment of sleep disorders in epilepsy. MATERIAL AND METHODS The search for data from domestic and foreign literary sources was carried out in the electronic databases Medline (PubMed), Scopus, Web of Science, eLibrary, CyberLeninka, Google Scholar. RESULTS The data of modern randomized trials, meta-analyzes on the effectiveness of various non-traditional methods as a method of choice for epilepsy with comorbid sleep disorders have been analyzed. CONCLUSIONS Complementary (alternative) treatments have many advantages over the classical pharmacotherapy of sleep disorders in epilepsy, in the form of non-invasiveness, low incidence of side-effects, ease of use, and lack of a dose-dependent effect. Of course, the targets of most of the above methods are not focused and not very specific, and the sample size is too small to obtain impartial and meaningful clinical conclusions, but this once again emphasizes the urgent need for large-scale clinical trials, which is necessary to develop evidence-based treatments for comorbid sleep disorders in epilepsy.
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Affiliation(s)
- A G Zhidik
- State Research Center - Burnasyan Federal Medical Biophysical Center, Moscow, Russia
| | - A B Kozhokaru
- State Research Center - Burnasyan Federal Medical Biophysical Center, Moscow, Russia
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia
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Ebrahim AA, Tungu A. Neuromodulation for temporal lobe epilepsy: a scoping review. ACTA EPILEPTOLOGICA 2022. [DOI: 10.1186/s42494-022-00086-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractTemporal lobe epilepsy (TLE) is difficult to treat as it is often refractory to treatment. Apart from traditional medical treatment, surgical resection is also a choice of treatment, but it may be associated with significant cognitive deficits. As a result, treatment strategies using targeted and adjustable stimulation of malfunctioning brain circuits have been developed. These neuromodulatory therapies using approaches of electric and magnetic neuromodulation are already in clinical use for refractory epilepsy while others such as optogenetics, chemo-genetics and ultrasound modulation are being tested in pre-clinical TLE animal models. In this review, we conducted an in-depth literature search on the clinically available neuromodulatory approaches for TLE, focusing on the possible mechanism of action and the clinical outcomes including adverse effects. Techniques that are currently explored in preclinical animal models but may have therapeutic applications in future are also discussed. The efficacy and subsequent adverse effects vary among the different neuromodulatory approaches and some still have unclear mechanisms of action in TLE treatment. Further studies evaluating the benefits and potential limitations are needed. Continued research on the therapeutic mechanisms and the epileptic brain network is critical for improving therapies for TLE.
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Current Status of Neuromodulation-Induced Cortical Prehabilitation and Considerations for Treatment Pathways in Lower-Grade Glioma Surgery. LIFE (BASEL, SWITZERLAND) 2022; 12:life12040466. [PMID: 35454957 PMCID: PMC9024440 DOI: 10.3390/life12040466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/19/2022] [Accepted: 03/19/2022] [Indexed: 12/15/2022]
Abstract
The infiltrative character of supratentorial lower grade glioma makes it possible for eloquent neural pathways to remain within tumoural tissue, which renders complete surgical resection challenging. Neuromodulation-Induced Cortical Prehabilitation (NICP) is intended to reduce the likelihood of premeditated neurologic sequelae that otherwise would have resulted in extensive rehabilitation or permanent injury following surgery. This review aims to conceptualise current approaches involving Repetitive Transcranial Magnetic Stimulation (rTMS-NICP) and extraoperative Direct Cortical Stimulation (eDCS-NICP) for the purposes of inducing cortical reorganisation prior to surgery, with considerations derived from psychiatric, rehabilitative and electrophysiologic findings related to previous reports of prehabilitation. Despite the promise of reduced risk and incidence of neurologic injury in glioma surgery, the current data indicates a broad but compelling possibility of effective cortical prehabilitation relating to perisylvian cortex, though it remains an under-explored investigational tool. Preliminary findings may prove sufficient for the continued investigation of prehabilitation in small-volume lower-grade tumour or epilepsy patients. However, considering the very low number of peer-reviewed case reports, optimal stimulation parameters and duration of therapy necessary to catalyse functional reorganisation remain equivocal. The non-invasive nature and low risk profile of rTMS-NICP may permit larger sample sizes and control groups until such time that eDCS-NICP protocols can be further elucidated.
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Zhou J, Fogarty A, Pfeifer K, Seliger J, Fisher RS. EEG Evoked Potentials to Repetitive Transcranial Magnetic Stimulation in Normal Volunteers: Inhibitory TMS EEG Evoked Potentials. SENSORS 2022; 22:s22051762. [PMID: 35270910 PMCID: PMC8915089 DOI: 10.3390/s22051762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 12/10/2022]
Abstract
The impact of repetitive magnetic stimulation (rTMS) on cortex varies with stimulation parameters, so it would be useful to develop a biomarker to rapidly judge effects on cortical activity, including regions other than motor cortex. This study evaluated rTMS-evoked EEG potentials (TEP) after 1 Hz of motor cortex stimulation. New features are controls for baseline amplitude and comparison to control groups of sham stimulation. We delivered 200 test pulses at 0.20 Hz before and after 1500 treatment pulses at 1 Hz. Sequences comprised AAA = active stimulation with the same coil for test–treat–test phases (n = 22); PPP = realistic placebo coil stimulation for all three phases (n = 10); and APA = active coil stimulation for tests and placebo coil stimulation for treatment (n = 15). Signal processing displayed the evoked EEG waveforms, and peaks were measured by software. ANCOVA was used to measure differences in TEP peak amplitudes in post-rTMS trials while controlling for pre-rTMS TEP peak amplitude. Post hoc analysis showed reduced P60 amplitude in the active (AAA) rTMS group versus the placebo (APA) group. The N100 peak showed a treatment effect compared to the placebo groups, but no pairwise post hoc differences. N40 showed a trend toward increase. Changes were seen in widespread EEG leads, mostly ipsilaterally. TMS-evoked EEG potentials showed reduction of the P60 peak and increase of the N100 peak, both possibly reflecting increased slow inhibition after 1 Hz of rTMS. TMS-EEG may be a useful biomarker to assay brain excitability at a seizure focus and elsewhere, but individual responses are highly variable, and the difficulty of distinguishing merged peaks complicates interpretation.
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da Costa CC, Martins LAM, Koth AP, Ramos JMO, Guma FTCR, de Oliveira CM, Pedra NS, Fischer G, Helena ES, Gioda CR, Sanches PRS, Junior ASV, Soares MSP, Spanevello RM, Gamaro GD, de Souza ICC. Static Magnetic Stimulation Induces Changes in the Oxidative Status and Cell Viability Parameters in a Primary Culture Model of Astrocytes. Cell Biochem Biophys 2021; 79:873-885. [PMID: 34176101 DOI: 10.1007/s12013-021-01015-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/24/2022]
Abstract
Astrocytes play an important role in the central nervous system function and may contribute to brain plasticity response during static magnetic fields (SMF) brain therapy. However, most studies evaluate SMF stimulation in brain plasticity while few studies evaluate the consequences of SMF at the cellular level. Thus, we here evaluate the effects of SMF at 305 mT (medium-intensity) in a primary culture of healthy/normal cortical astrocytes obtained from neonatal (1 to 2-day-old) Wistar rats. After reaching confluence, cells were daily subjected to SMF stimulation for 5 min, 15 min, 30 min, and 40 min during 7 consecutive days. Oxidative stress parameters, cell cycle, cell viability, and mitochondrial function were analyzed. The antioxidant capacity was reduced in groups stimulated for 5 and 40 min. Although no difference was observed in the enzymatic activity of superoxide dismutase and catalase or the total thiol content, lipid peroxidation was increased in all stimulated groups. The cell cycle was changed after 40 min of SMF stimulation while 15, 30, and 40 min led cells to death by necrosis. Mitochondrial function was reduced after SMF stimulation, although imaging analysis did not reveal substantial changes in the mitochondrial network. Results mainly revealed that SMF compromised healthy astrocytes' oxidative status and viability. This finding reveals how important is to understand the SMF stimulation at the cellular level since this therapeutic approach has been largely used against neurological and psychiatric diseases.
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Affiliation(s)
- Caroline Crespo da Costa
- NeuroCell Laboratory, Universidade Federal de Pelotas Campus Universitário, S/N, Capão do Leão-RS, 96160-000, Brasil
| | - Léo Anderson Meira Martins
- Department of Physiology, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, Bairro Centro Histórico, Porto Alegre, Rio Grande do Sul, 90050-170, Brasil
| | - André Peres Koth
- NeuroCell Laboratory, Universidade Federal de Pelotas Campus Universitário, S/N, Capão do Leão-RS, 96160-000, Brasil
| | - Jéssica Marques Obelar Ramos
- NeuroCell Laboratory, Universidade Federal de Pelotas Campus Universitário, S/N, Capão do Leão-RS, 96160-000, Brasil
| | - Fátima Theresinha Costa Rodrigues Guma
- Department of Biochemistry, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600, Bairro Santa Cecília, Porto Alegre, Rio Grande do Sul, 90035-000, Brasil
| | - Cleverson Moraes de Oliveira
- Department of Biochemistry, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600, Bairro Santa Cecília, Porto Alegre, Rio Grande do Sul, 90035-000, Brasil
| | - Nathália Stark Pedra
- Laboratory of Neurochemistry, Inflammation and Cancer, Universidade Federal de Pelotas Campus Universitário, S/N, Capão do Leão-RS, 96160-000, Brasil
| | - Geferson Fischer
- Laboratory of Virology and Immunology, Universidade Federal de Pelotas Campus Universitário, S/N, Capão do Leão-RS, 96160-000, Brasil
| | - Eduarda Santa Helena
- Department of Physiological Sciences, Universidade Federal de Rio Grande Avenida Itália, Km 8, Bairro Carreiros, Rio Grande, Rio Grande do Sul, 96203-900, Brasil
| | - Carolina Rosa Gioda
- Department of Physiological Sciences, Universidade Federal de Rio Grande Avenida Itália, Km 8, Bairro Carreiros, Rio Grande, Rio Grande do Sul, 96203-900, Brasil
| | - Paulo Roberto Stefani Sanches
- Laboratory of the Research and Development Service in Biomedical Engineering- Hospital de Clínicas de Porto Alegre Rua Ramiro Barcelos, 2350- Bairro Santa Cecília, Porto Alegre-RS, 90035-903, Brasil
| | - Antonio Sergio Varela Junior
- Institute of Biological Science, Universidade Federal do Rio Grande Avenida Itália, Km 8, Bairro Carreiros, Rio Grande, Rio Grande do Sul, 96203-900, Brasil
| | - Mayara Sandrielly Pereira Soares
- Laboratory of Neurochemistry, Inflammation and Cancer, Universidade Federal de Pelotas Campus Universitário, S/N, Capão do Leão-RS, 96160-000, Brasil
| | - Rosélia Maria Spanevello
- Laboratory of Neurochemistry, Inflammation and Cancer, Post-Graduate Program in Biochemistry and Bioprospection, Universidade Federal de Pelotas Campus Universitário, S/N, Capão do Leão-RS, 96160-000, Brasil
| | - Giovana Duzzo Gamaro
- NeuroCell Laboratory, Universidade Federal de Pelotas Campus Universitário, S/N, Capão do Leão-RS, 96160-000, Brasil
| | - Izabel Cristina Custódio de Souza
- Coordinator of NeuroCell Laboratory, Laboratory of Histology, Department of Morphology, Post-Graduate Program in Biochemistry and Bioprospection, Universidade Federal de Pelotas Avenida Duque de Caxias, 250, 96030-000, Pelotas, Rio Grande do Sul, Brasil.
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Fu C, Aisikaer A, Chen Z, Yu Q, Yin J, Yang W. Antiepileptic Efficacy and Network Connectivity Modulation of Repetitive Transcranial Magnetic Stimulation by Vertex Suppression. Front Hum Neurosci 2021; 15:667619. [PMID: 34054450 PMCID: PMC8155627 DOI: 10.3389/fnhum.2021.667619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/12/2021] [Indexed: 11/25/2022] Open
Abstract
A core feature of drug-resistant epilepsy is hyperexcitability in the motor cortex, and low-frequency repetitive transcranial magnetic stimulation (rTMS) is a suitable treatment for seizures. However, the antiepileptic effect causing network reorganization has rarely been studied. Here, we assessed the impact of rTMS on functional network connectivity (FNC) in resting functional networks (RSNs) and their relation to treatment response. Fourteen patients with medically intractable epilepsy received inhibitive rTMS with a figure-of-eight coil over the vertex for 10 days spread across two weeks. We designed a 6-week follow-up phase divided into four time points to investigate FNC and rTMS-induced timing-dependent plasticity, such as seizure frequency and abnormal interictal discharges on electroencephalography (EEG). For psychiatric comorbidities, the Hamilton Depression Scale (HAM-D) and the Hamilton Anxiety Scale (HAM-A) were applied to measure depression and anxiety before and after rTMS. FNC was also compared to that of a cohort of 17 healthy control subjects. The after-effects of rTMS included all subjects that achieved the significant decrease rate of more than 50% in interictal epileptiform discharges and seizure frequency, 12 (14) patients with the reduction rate above 50% compared to the baseline, as well as emotional improvements in depression and anxiety (p < 0.05). In the analysis of RSNs, we found a higher synchronization between the sensorimotor network (SMN) and posterior default-mode network (pDMN) in epileptic patients than in healthy controls. In contrast to pre-rTMS, the results demonstrated a weaker FNC between the anterior DMN (aDMN) and SMN after rTMS, while the FNC between the aDMN and dorsal attention network (DAN) was greater (p < 0.05, FDR corrected). Importantly, the depressive score was anticorrelated with the FNC of the aDMN-SMN (r = −0.67, p = 0.0022), which was markedly different in the good and bad response groups treated with rTMS (p = 0.0115). Based on the vertex suppression by rTMS, it is possible to achieve temporary clinical efficacy by modulating network reorganization in the DMN and SMN for patients with refractory epilepsy.
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Affiliation(s)
- Cong Fu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Aikedan Aisikaer
- Department of Radiology, Tianjin First Central Hospital, Tianjin Medical University, Tianjin, China
| | - Zhijuan Chen
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Qing Yu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Jianzhong Yin
- Department of Radiology, Tianjin First Central Hospital, Tianjin Medical University, Tianjin, China
| | - Weidong Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
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Walton D, Spencer DC, Nevitt SJ, Michael BD. Transcranial magnetic stimulation for the treatment of epilepsy. Cochrane Database Syst Rev 2021; 4:CD011025. [PMID: 33884611 PMCID: PMC8092469 DOI: 10.1002/14651858.cd011025.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Epilepsy is a highly prevalent neurological condition characterised by repeated unprovoked seizures with various aetiologies. Although antiepileptic medications produce clinical improvement in many individuals, nearly a third of individuals have drug-resistant epilepsy that carries significant morbidity and mortality, and even individuals who have clinical improvement from antiepileptic medications often report iatrogenic symptoms. There remains a need for non-invasive and more effective therapies for this population. Transcranial magnetic stimulation (TMS) uses electromagnetic coils to excite or inhibit neurons, with repetitive pulses at low-frequency producing an inhibitory effect that could conceivably reduce cortical excitability associated with epilepsy. This is an updated version of the original Cochrane Review published in 2016. OBJECTIVES To assess the evidence for the use of TMS in individuals with drug-resistant epilepsy compared with other available treatments in reducing seizure frequency, improving quality of life, reducing epileptiform discharges, antiepileptic medication use, and side effects. SEARCH METHODS For the latest update, we searched the Cochrane Register of Studies (CRS Web) and MEDLINE (Ovid 1946 to 2 June 2020). CRS Web includes randomised or quasi-randomised controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), the Cochrane Central Register of Controlled Trials (CENTRAL), and the specialised registers of Cochrane Review Groups including Epilepsy. SELECTION CRITERIA We included randomised controlled trials that were double-blinded, single-blinded, or unblinded, and placebo controlled, no treatment, or active controlled, which used repetitive transcranial magnetic stimulation (rTMS) without restriction of frequency, coil, duration or intensity on participants with drug-resistant epilepsy. DATA COLLECTION AND ANALYSIS We extracted information from each trial including methodological data; participant demographics including baseline seizure frequency, type of epileptic drugs taken; intervention details and intervention groups for comparison; potential biases; and outcomes and time points, primarily change in seizure frequency or responder rates, as well as quality of life and epileptiform discharges, adverse effects, and changes in medication use. MAIN RESULTS The original search revealed 274 records from the databases that after selection provided seven full-text relevant studies for inclusion. The latest search identified 179 new records from the databases that after evaluation against the inclusion and exclusion criteria provided one additional full-text relevant study. The eight included studies (241 participants) were all randomised trials; seven of the studies were blinded. Methodological and design information in the included studies was unclear, particularly relating to randomisation and allocation concealment methods. We were not able to combine the results of the trials in analysis due to differences in the studies' designs. For the current update, two of the eight studies analysed showed a statistically significant reduction in seizure rate from baseline (72% and 78.9% reduction of seizures per week from the baseline rate, respectively), whilst the other six studies showed no statistically significant difference in seizure frequency following rTMS treatment compared with controls (low-certainty evidence). One study assessed quality of life and found that more participants showed improvement in quality of life scores with active treatments compared to the sham treatment, but this only involved seven participants (very low-certainty evidence). Four studies evaluated our secondary endpoint of mean number of epileptic discharges, three of which showed a statistically significant reduction in discharges after active rTMS treatment. Adverse effects were uncommon in the studies and typically involved headache, dizziness, and tinnitus; however increased seizure frequency did occur in a small number of individuals. The included trials reported no significant changes in medication use. Overall the risk of bias was either low or unclear, and the certainty of the evidence was low to very low. AUTHORS' CONCLUSIONS Overall, we judged the certainty of evidence for the primary outcomes of this review to be low to very low. We found some evidence to suggest that rTMS is safe but some adverse events were experienced. The variability in technique and outcome reporting prevented meta-analysis, and the evidence for efficacy of rTMS for seizure reduction is still lacking, despite reasonable evidence that it is effective at reducing epileptiform discharges.
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Affiliation(s)
- Dean Walton
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - David C Spencer
- Department of Neurology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Sarah J Nevitt
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Benedict D Michael
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Clinical Infection Microbiology and Neuroimmunology, Institute of Infection, Veterinary and Ecological Science, Liverpool, UK
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, UK
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Zhang T, Huang Y, Jin Y, Ma X, Liu Z. Treatment for Major Depressive Disorder by Repetitive Transcranial Magnetic Stimulation in Different Parameters: A Randomized Double-Blinded Controlled Trial. Front Psychiatry 2021; 12:623765. [PMID: 33889094 PMCID: PMC8055955 DOI: 10.3389/fpsyt.2021.623765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/22/2021] [Indexed: 02/03/2023] Open
Abstract
Background: Repetitive transcranial magnetic stimulation (rTMS) has been proven to be safe and effective in treating major depressive disorder (MDD). However, the treatment parameters of rTMS are still divergent and need to be optimized further. The aim of this study was to compare the efficacy of rTMS in treating MDD with different parameters of stimulating frequency and location, and course of treatment. Methods: A total of 221 patients with MDD were recruited in the randomized, double-blind, controlled trial. All eligible patients were randomly assigned into four treatment groups: (1) 10 Hz in left dorsolateral pre-frontal cortex (DLPFC) (n = 55), (2) 5 Hz in left DLPFC (n = 53), (3) 10 Hz in bilateral DLPFC (n = 57), and (4) 5 Hz in bilateral DLPFC (n = 56). The patients received treatment for 6 weeks and an additional 6-week optional treatment. The efficacies were evaluated by Hamilton Depression Rating Scale-24 items (HDRS) and Clinical Global Impressions Scale (CGI). The trial is registered at the Chinese Clinical Trial Registry as ChiCTR-TRC-12002248. Results: The ANOVAs of HDRS scores up to 6 weeks and 12 weeks with repeated measure of time showed a significant effect of duration without statistical difference among four treatment groups and no significance when time was interacted with inter-group as well. The response rates up until the 5th week were significantly different with the previous week. Conclusions: It concludes that there were no statistical differences in the efficacy of rTMS between unilateral left and bilateral DLPFC, and between 5 and 10 Hz for treating MDD.
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Affiliation(s)
- Tingting Zhang
- National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
| | - Yueqin Huang
- National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
| | - Yi Jin
- Brain Health Leadership Foundation, Reno, NV, United States
| | - Xiaoyan Ma
- National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
| | - Zhaorui Liu
- National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
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12
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Dong L, Li G, Gao Y, Lin L, Zhang KH, Tian CX, Cao XB, Zheng Y. Effect of priming low-frequency magnetic fields on zero-Mg2+ -induced epileptiform discharges in rat hippocampal slices. Epilepsy Res 2020; 167:106464. [DOI: 10.1016/j.eplepsyres.2020.106464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/02/2020] [Accepted: 09/05/2020] [Indexed: 12/16/2022]
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13
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Üstün Özek S, Gürses C, Bebek N, Baykan B, Gökyiğit A, Öge AE. Slow repetitive transcranial magnetic stimulation in refractory juvenile myoclonic epilepsies. Epilepsy Behav 2020; 112:107479. [PMID: 33181910 DOI: 10.1016/j.yebeh.2020.107479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/06/2020] [Accepted: 09/06/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of the study was to investigate the effects of slow repetitive transcranial magnetic stimulation (rTMS) on patients with refractory juvenile myoclonic epilepsy (JME). METHODS One thousand pulses with the intensity of 120% active motor threshold (AMT) at 0.2 Hz frequency were applied on 5 consecutive days in 10 patients with refractory JME. Sham rTMS was performed after 3 months. Electroencephalography (EEG) examinations were performed before rTMS, on the 5th day, and 1, 2, 4, and 8 weeks after rTMS. Resting motor threshold (RMT), AMT, and cortical silent periods (CSPs) were recorded before the application and at the end of day 5. The changes in the quality of life were evaluated using the Quality of Life in Epilepsy Inventory (QOLIE-31). RESULTS No adverse effects were observed. The number of seizures decreased by 29-50%, and interictal discharge durations decreased 2 weeks after the real rTMS. No significant difference was observed between the AMT and RMT values recorded before and after the stimulations. Statistically significant increases in CSP duration and quality of life scores were found following real rTMS. Repetitive transcranial magnetic stimulation may be considered as a safe treatment option in refractory JME. CONCLUSION This study provides some positive evidence that rTMS may be effective in resistant JME.
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Affiliation(s)
- Sibel Üstün Özek
- Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey; Department of Neurology, University of Health Sciences Okmeydanı Training and Research Hospital, Istanbul, Turkey.
| | - Candan Gürses
- Department of Clinical Neurophysiology, Koç University, Istanbul, Turkey
| | - Nerses Bebek
- Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Betül Baykan
- Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ayşen Gökyiğit
- Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - A Emre Öge
- Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Charalambous M, Van Ham L, Broeckx BJG, Roggeman T, Carrette S, Vonck K, Kervel RR, Cornelis I, Bhatti SFM. Repetitive transcranial magnetic stimulation in drug-resistant idiopathic epilepsy of dogs: A noninvasive neurostimulation technique. J Vet Intern Med 2020; 34:2555-2561. [PMID: 33009717 PMCID: PMC7694858 DOI: 10.1111/jvim.15919] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 01/08/2023] Open
Abstract
Background Although repetitive transcranial magnetic stimulation (rTMS) has been assessed in epileptic humans, clinical trials in epileptic dogs can provide additional insight. Objectives Evaluate the potential antiepileptic effect of rTMS in dogs. Animals Twelve client‐owned dogs with drug‐resistant idiopathic epilepsy (IE). Methods Single‐blinded randomized sham‐controlled clinical trial (dogs allocated to active or sham rTMS) (I) and open‐labeled uncontrolled clinical trial (dogs received active rTMS after sham rTMS) (II). Monthly seizure frequency (MSF), monthly seizure day frequency (MSDF), and number of cluster seizures (CS) were evaluated for a 3‐month pre‐TMS and post‐rTMS period and safety was assessed. The lasting effect period of rTMS was assessed in each dog treated by active stimulation using the MSF ratio (proportion of post‐TMS to pre‐rTMS MSF) and treatment was considered effective if the ratio was <1. Results No adverse effects were reported. In trial I, MSF and MSDF decreased significantly (P = .04) in the active group (n = 7). In the sham group (n = 5), no significant changes were found (P = .84 and .29, respectively). Cluster seizures did not change significantly in either group. No significant differences were detected between the groups. In trial II, previously sham‐treated dogs (n = 5) received active rTMS and significant decreases in MSF and MSDF were noted (P = .03 and .008, respectively). The overall effect of rTMS lasted for 4 months; thereafter, the MSF ratio was >1. Conclusions and Clinical Importance Repetitive transcranial magnetic stimulation may be a safe adjunctive treatment option for dogs with drug‐resistant IE, but large‐scale studies are needed to establish firm conclusions.
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Affiliation(s)
- Marios Charalambous
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Luc Van Ham
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Bart J G Broeckx
- Department of Nutrition, Genetics and Ethology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Tom Roggeman
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sofie Carrette
- Department of Neurology, Ghent University Hospital, 4Brain, Ghent University, Ghent, Belgium
| | - Kristi Vonck
- Department of Neurology, Ghent University Hospital, 4Brain, Ghent University, Ghent, Belgium
| | - Roelof R Kervel
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Ine Cornelis
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sofie F M Bhatti
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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15
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Tsuboyama M, Kaye HL, Rotenberg A. Review of Transcranial Magnetic Stimulation in Epilepsy. Clin Ther 2020; 42:1155-1168. [PMID: 32624320 DOI: 10.1016/j.clinthera.2020.05.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 05/18/2020] [Accepted: 05/27/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Despite the availability of numerous pharmacologic and nonpharmacologic antiseizure therapies, a fraction of patients with epilepsy remain refractory to current treatment options, underscoring the need for novel drugs and neuromodulatory therapies. Transcranial magnetic stimulation (TMS), coupled with either electromyography or electroencephalography, enables rapid measurement of the cortical excitation/inhibition ratio, which is pathologically shifted toward excess excitability in patients with epilepsy. In this review, we summarize: (1) TMS protocols that have been deployed to identify promising compounds in the antiepilepsy drug (AED)-development pipeline, and (2) the therapeutic potential of TMS in the treatment of drug-resistant seizures. METHODS A focused literature review of the use of TMS in epilepsy, using a PubMed search, was performed. Over 70 articles were included that pertained to: (1) the use of TMS-EMG and TMS-EEG in elucidating the mechanisms of action of AEDs and in discovering potential new AEDs; and (2) the use of repetitive TMS in the treatment of seizures. FINDINGS Studies from the literature have reported that AEDs alter TMS-derived metrics, typically by leading to a net increase in cortical inhibition with successful therapy. Preclinical TMS work in rodent models of epilepsy has led to the development of novel antiseizure drug compounds. Clinical translational studies of TMS have been used to determine guidelines on the dosages of other agents in the AED pipeline in preparation for clinical trials. Several studies have described the use of therapeutic repetitive TMS in both the ictal and interictal states of epilepsy, with inconsistent results. IMPLICATIONS TMS has diagnostic and therapeutic potential in epilepsy. TMS-derived markers can enable early-stage measures of AED target engagement, and can facilitate studies of the pharmacokinetic and pharmacodynamic properties of AEDs. TMS may also be used in the early prediction of the efficacy of different AEDs in treating patients, and in direct neuromodulation of epileptic networks. From the therapeutics perspective, despite favorable results in some trials, the optimization of treatment paradigms and the determination of ideal candidates for TMS are still needed. Finally, preclinical experiments of TMS have provided mechanistic insight into its effects on the excitation/inhibition ratio, and may facilitate rational drug-device coupling paradigms. Overall, the capacity of TMS in both the modulation and measurement of changes in cortical excitability highlights its unique role in advancing antiepilepsy therapeutics.
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Affiliation(s)
- Melissa Tsuboyama
- Neuromodulation Program, Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Boston, MA, USA; FM Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Harper L Kaye
- Behavioral Neuroscience Program, Boston University School of Medicine, Boston, MA, USA
| | - Alexander Rotenberg
- Neuromodulation Program, Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Boston, MA, USA; FM Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, USA; Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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16
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Abstract
AbstractEpilepsy is a common disease with frequent occurrences. Many precipitating factors contribute to epileptic seizures, such as hyperventilation and alcohol consumption. An increasing number of studies have also found that electromagnetic activity in the environment can also affect epileptic seizures. However, many neuromodulatory devices that produce electromagnetic fields have been applied in the diagnosis and treatment of epilepsy. In this paper, we performed literature search in the PubMed, Medline and EMBASE databases and reviewed retrospective, prospective, or cross-sectional studies and case reports on the effects of electromagnetic activity on epilepsy. The application of electromagnetic activity in the diagnosis and treatment of epilepsy is also reviewed.
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17
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Hamed SA. Cortical excitability in epilepsy and the impact of antiepileptic drugs: transcranial magnetic stimulation applications. Expert Rev Neurother 2020; 20:707-723. [PMID: 3251028 DOI: 10.1080/14737175.2020.1780122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Epileptic conditions are characterized by impaired cortical excitation/inhibition balance and interneuronal disinhibition. Transcranial magnetic stimulation (TMS) is a neurophysiological method that assesses brain excitation/inhibition. AREA COVERED This review was written after a detailed search in PubMed, EMBASE, ISI web of science, SciELO, Scopus, and Cochrane Controlled Trials databases from 1990 to 2020. It summarizes TMS applications for diagnostic and therapeutic purposes in epilepsy. TMS studies help to distinguish different epilepsy conditions and explore the antiepileptic drugs' (AEDs') effects on neuronal microcircuits and plasticity mechanisms. Repetitive TMS studies showed that low-frequency rTMS (0.33-1 Hz) can reduce seizures' frequency in refractory epilepsy or pause ongoing seizures; however, there is no current approval for its use in such patients as adjunctive treatment to AEDs. EXPERT OPINION There are variable and conflicting TMS results which reflect the distinct pathogenic mechanisms of each epilepsy condition, the dynamic epileptogenic process over the long disease course resulting in the development of recurrent spontaneous seizures and/or progression of epilepsy after it is established, and the differential effect of AEDs on cortical excitability. Future epilepsy research should focus on combined TMS/functional connectivity studies that explore the complex cortical excitability circuits and networks using different TMS parameters and techniques.
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Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital , Assiut, Egypt
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18
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19
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Mishra A, Maiti R, Mishra BR, Jena M, Srinivasan A. Effect of Repetitive Transcranial Magnetic Stimulation on Seizure Frequency and Epileptiform Discharges in Drug-Resistant Epilepsy: A Meta-Analysis. J Clin Neurol 2020; 16:9-18. [PMID: 31942753 PMCID: PMC6974817 DOI: 10.3988/jcn.2020.16.1.9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 01/08/2023] Open
Abstract
Background and Purpose The role of low-frequency repetitive transcranial stimulation (rTMS) in drug-resistant epilepsy (DRE) has been conflicting and inconclusive in previous clinical trials. This meta-analysis evaluated the efficacy of rTMS on seizure frequency and epileptiform discharges in DRE. Methods A standard meta-analysis protocol was registered in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO: CRD42018088544). After performing a comprehensive literature search using specific keywords in MEDLINE, the Cochrane database, and the International Clinical Trial Registry Platform (ICTRP), reviewers assessed the eligibility and extracted data from seven relevant clinical trials. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed in the selection, analysis, and reporting of findings. A random-effects model was used to estimate the effect size as the mean difference in seizure frequency and interictal epileptiform discharges between the groups. Quality assessment was performed using a risk-of-bias assessment tool, and a meta-regression was used to identify the variables that probably influenced the effect size. Results The random-effects model analysis revealed a pooled effect size of −5.96 (95% CI= −8.98 to −2.94), significantly favoring rTMS stimulation (p=0.0001) over the control group with regard to seizure frequency. The overall effect size for interictal epileptiform discharges also significantly favored rTMS stimulation (p<0.0001), with an overall effect size of −9.36 (95% CI=−13.24 to −5.47). In the meta-regression, the seizure frequency worsened by 2.00±0.98 (mean±SD, p=0.042) for each week-long lengthening of the posttreatment follow-up period, suggesting that rTMS exerts only a short-term effect. Conclusions This meta-analysis shows that rTMS exerts a significant beneficial effect on DRE by reducing both the seizure frequency and interictal epileptiform discharges. However, the meta-regression revealed only an ephemeral effect of rTMS.
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Affiliation(s)
- Archana Mishra
- Department of Pharmacology and Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Rituparna Maiti
- Department of Pharmacology and Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India.
| | - Biswa Ranjan Mishra
- Department of Pharmacology and Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Monalisa Jena
- Department of Pharmacology and Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Anand Srinivasan
- Department of Pharmacology and Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
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20
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Fisher R, Zhou J, Fogarty A, Joshi A, Markert M, Deutsch GK, Velez M. Repetitive transcranial magnetic stimulation directed to a seizure focus localized by high-density EEG: A case report. EPILEPSY & BEHAVIOR CASE REPORTS 2018; 10:47-53. [PMID: 29984172 PMCID: PMC6031434 DOI: 10.1016/j.ebcr.2018.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/07/2018] [Accepted: 03/19/2018] [Indexed: 12/29/2022]
Abstract
We demonstrate feasibility of using high-density EEG to map a neocortical seizure focus in conjunction with delivery of magnetic therapy. Our patient had refractory seizures affecting the left leg. A five-day course of placebo stimulation followed a month later by active rTMS was directed to the mapped seizure dipole. Active rTMS resulted in reduced EEG spiking, and shortening of seizure duration compared to placebo. Seizure frequency, however, improved similarly in both placebo and active treatment stages. rTMS-evoked EEG potentials demonstrated that a negative peak at 40 ms - believed to represent GABAergic inhibition - was enhanced by stimulation.
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Affiliation(s)
- Robert Fisher
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Jing Zhou
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Adam Fogarty
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Aditya Joshi
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Matthew Markert
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Gayle K Deutsch
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Mariel Velez
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
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Neurostimulation for drug-resistant epilepsy: a systematic review of clinical evidence for efficacy, safety, contraindications and predictors for response. Curr Opin Neurol 2018; 31:198-210. [DOI: 10.1097/wco.0000000000000534] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Wang YQ, Zhang MQ, Li R, Qu WM, Huang ZL. The Mutual Interaction Between Sleep and Epilepsy on the Neurobiological Basis and Therapy. Curr Neuropharmacol 2018; 16:5-16. [PMID: 28486925 PMCID: PMC5771383 DOI: 10.2174/1570159x15666170509101237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 07/11/2017] [Accepted: 04/27/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sleep and epilepsy are mutually related in a complex, bidirectional manner. However, our understanding of this relationship remains unclear. RESULTS The literatures of the neurobiological basis of the interactions between sleep and epilepsy indicate that non rapid eye movement sleep and idiopathic generalized epilepsy share the same thalamocortical networks. Most of neurotransmitters and neuromodulators such as adenosine, melatonin, prostaglandin D2, serotonin, and histamine are found to regulate the sleep-wake behavior and also considered to have antiepilepsy effects; antiepileptic drugs, in turn, also have effects on sleep. Furthermore, many drugs that regulate the sleep-wake cycle can also serve as potential antiseizure agents. The nonpharmacological management of epilepsy including ketogenic diet, epilepsy surgery, neurostimulation can also influence sleep. CONCLUSION In this paper, we address the issues involved in these phenomena and also discuss the various therapies used to modify them.
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Affiliation(s)
| | | | - Rui Li
- Department of Pharmacology and Shanghai Key Laboratory of Bioactive Small Molecules, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation
Center for Brain Science, Fudan University, Shanghai200032, P.R. China
| | - Wei-Min Qu
- Department of Pharmacology and Shanghai Key Laboratory of Bioactive Small Molecules, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation
Center for Brain Science, Fudan University, Shanghai200032, P.R. China
| | - Zhi-Li Huang
- Department of Pharmacology and Shanghai Key Laboratory of Bioactive Small Molecules, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation
Center for Brain Science, Fudan University, Shanghai200032, P.R. China
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23
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Cooper YA, Pianka ST, Alotaibi NM, Babayan D, Salavati B, Weil AG, Ibrahim GM, Wang AC, Fallah A. Repetitive transcranial magnetic stimulation for the treatment of drug-resistant epilepsy: A systematic review and individual participant data meta-analysis of real-world evidence. Epilepsia Open 2017; 3:55-65. [PMID: 29588988 PMCID: PMC5839309 DOI: 10.1002/epi4.12092] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 12/31/2022] Open
Abstract
Objective To perform a systematic review and meta‐analysis of real‐world evidence for the use of low‐frequency repetitive transcranial magnetic stimulation (rTMS) in the treatment of drug‐resistant epilepsy. Methods We systematically searched PubMed, Scopus, Medline, and clinicaltrials.gov for all relevant articles. Relevant patient and stimulation predictors as well as seizure outcomes were assessed. For studies with and without individual participant data (IPD), the primary outcomes were the rate of “favorable response” (reduction in seizure frequency ≥50%) and pooled event rate of mean reduction in seizure frequency, respectively. Outcomes were assessed with comparative statistics and random‐effects meta‐analysis models. Results Of 3,477 identified articles, 12 met eligibility and were included in this review. We were able to obtain IPD for 5 articles constituting 34 participants. Univariate analysis on IPD identified greater favorable response event rates between participants with temporal seizure focus versus extratemporal (50% vs. 14%, p = 0.045) and between participants who were stimulated with a figure‐8 coil versus other types (47% vs. 0%, p = 0.01). We also performed study‐level meta‐analysis on the remaining 7 studies without IPD, which included 212 participants. The pooled mean event rate of 50% seizure reduction using low‐frequency rTMS was 30% (95% confidence interval [CI] 12–57%). Sensitivity analysis revealed that studies with a mean age ≤21 years and studies using targeted stimulation had the highest seizure reduction rates compared to studies with a mean age >21 years (69% vs. 18%) and not using a targeted stimulation (47% vs. 14–20%). Moreover, we identified high interstudy heterogeneity, moderate study bias, and high publication bias. Significance Real‐world evidence suggests that low‐frequency rTMS using a figure‐8 coil may be an effective therapy for the treatment of drug‐resistant epilepsy in pediatric patients. This meta‐analysis can inform the design and expedite recruitment of a subsequent randomized clinical trial.
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Affiliation(s)
- Yonatan A Cooper
- David Geffen School of Medicine University of California Los Angeles Los Angeles California U.S.A
| | - Sean T Pianka
- David Geffen School of Medicine University of California Los Angeles Los Angeles California U.S.A
| | - Naif M Alotaibi
- Division of Neurosurgery Department of Surgery University of Toronto Toronto Ontario Canada
| | - Diana Babayan
- Department of Neurosurgery David Geffen School of Medicine at University of California Los Angeles UCLA Mattel Children's Hospital Los Angeles California U.S.A
| | - Bahar Salavati
- Faculty of Medicine Institute of Medical Science University of Toronto Toronto Ontario Canada.,Temerty Centre for Therapeutic Brain Intervention Centre for Addiction and Mental Health Toronto Ontario Canada
| | - Alexander G Weil
- Division of Pediatric Neurosurgery Department of Surgery Sainte Justine Hospital University of Montreal Montreal Quebec Canada
| | - George M Ibrahim
- Division of Neurosurgery Department of Surgery University of Toronto Toronto Ontario Canada.,Division of Neurosurgery Hospital for Sick Children University of Toronto Toronto Ontario Canada
| | - Anthony C Wang
- Division of Neurosurgery Hospital for Sick Children University of Toronto Toronto Ontario Canada
| | - Aria Fallah
- Department of Neurosurgery David Geffen School of Medicine at University of California Los Angeles UCLA Mattel Children's Hospital Los Angeles California U.S.A.,Department of Health Policy and Management Jonathan and Karin Fielding School of Public Health University of California Los Angeles Los Angeles California U.S.A
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Zheng Y, Ma W, Dong L, Dou JR, Gao Y, Xue J. Influence of the on-line ELF-EMF stimulation on the electrophysiological properties of the rat hippocampal CA1 neurons in vitro. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2017; 88:105106. [PMID: 29092489 DOI: 10.1063/1.5006520] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The extremely low frequency electromagnetic fields (ELF-EMFs) have been shown to have an environmentally negative effect on humans' health; however, its treatment effect is beneficial for patients suffering from neurological disorders. Despite this success, the application of ELF-EMF has exceeded in the understanding of its internal mechanism. Recently, it was found that on-line magnetic stimulation may offer advantages over off-line magnetic exposure and has proven to be effective in activating the prefrontal cortex pyramidal neurons in vitro. Here, we perform computational simulations of the stimulation coils in COMSOL modeling to describe the uniformity of the distribution of the on-line magnetic field. Interestingly, the modeling data and actual measurements showed that the densities of the magnetic flux that was generated by the on-line stimulation coils were similar. The on-line magnetic stimulator induced sodium channel currents as well as field excitatory postsynaptic potentials of the rat hippocampal CA1 neurons and successfully demonstrated its extensive applications to activate neuronal tissue. These findings further raise the possibility that the instrument of on-line magnetic stimulation may be an effective alternative for studies in the field of bioelectromagnetics.
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Affiliation(s)
- Yu Zheng
- School of Electronics and Information Engineering, Tianjin Polytechnic University, Tianjin 300387, China
| | - Wei Ma
- School of Electronics and Information Engineering, Tianjin Polytechnic University, Tianjin 300387, China
| | - Lei Dong
- State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin University, Tianjin 300072, China
| | - Jun-Rong Dou
- School of Electronics and Information Engineering, Tianjin Polytechnic University, Tianjin 300387, China
| | - Yang Gao
- School of Electronics and Information Engineering, Tianjin Polytechnic University, Tianjin 300387, China
| | - Jing Xue
- School of Electronics and Information Engineering, Tianjin Polytechnic University, Tianjin 300387, China
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25
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Abstract
The revolution in theory, swift technological developments, and invention of new devices have driven tremendous progress in neurostimulation as a third‐line treatment for epilepsy. Over the past decades, neurostimulation took its place in the field of epilepsy as an advanced treatment technique and opened up a new world. Numerous animal studies have proven the physical efficacy of stimulation of the brain and peripheral nerves. Based on this optimistic fundamental research, new advanced techniques are being explored in clinical practice. Over the past century, drawing on the benefits brought about by vagus nerve stimulation for the treatment of epilepsy, various new neurostimulation modalities have been developed to control seizures. Clinical studies including case reports, case series, and clinical trials have been booming in the past several years. This article gives a comprehensive review of most of these clinical studies. In addition to highlighting the advantages of neurostimulation for the treatment of epilepsy, concerns with this modality and future development directions are also discussed. The biggest advantage of neurostimulation over pharmacological treatments for epilepsy is the modulation of the epilepsy network by delivering stimuli at a specific target or the “hub.” Conversely, however, a lack of knowledge of epilepsy networks and the mechanisms of neurostimulation may hinder further development. Therefore, theoretical research on the mechanism of epileptogenesis and epilepsy networks is needed in the future. Within the multiple modalities of neuromodulation, the final choice should be made after full discussion with a multidisciplinary team at a presurgical conference. Furthermore, the establishment of a neurostimulation system with standardized parameters and rigorous guidelines is another important issue. To achieve this goal, a worldwide collaboration of epilepsy centers is also suggested in the future.
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Affiliation(s)
- Yicong Lin
- Department of Neurology Xuanwu Hospital Capital Medical University Beijing China.,Beijing Key Laboratory of Neuromodulation Beijing China.,Center of Epilepsy Beijing Institute for Brain Disorders Capital Medical University Beijing China
| | - Yuping Wang
- Department of Neurology Xuanwu Hospital Capital Medical University Beijing China.,Beijing Key Laboratory of Neuromodulation Beijing China.,Center of Epilepsy Beijing Institute for Brain Disorders Capital Medical University Beijing China
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26
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Zheng Y, Dou JR, Gao Y, Dong L, Li G. Effects of 15 Hz square wave magnetic fields on the voltage-gated sodium and potassium channels in prefrontal cortex pyramidal neurons. Int J Radiat Biol 2016; 93:449-455. [DOI: 10.1080/09553002.2016.1259671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Yu Zheng
- School of Electronics and Information Engineering, Tianjin Polytechnic University, Tianjin, China
| | - Jun-rong Dou
- School of Electronics and Information Engineering, Tianjin Polytechnic University, Tianjin, China
| | - Yang Gao
- School of Electronics and Information Engineering, Tianjin Polytechnic University, Tianjin, China
| | - Lei Dong
- School of Electronics and Information Engineering, Tianjin Polytechnic University, Tianjin, China
| | - Gang Li
- Tianjin Key Laboratory of Biomedical Detecting Techniques & Instruments, Tianjin University, Tianjin, China
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Larkin M, Meyer RM, Szuflita NS, Severson MA, Levine ZT. Post-Traumatic, Drug-Resistant Epilepsy and Review of Seizure Control Outcomes from Blinded, Randomized Controlled Trials of Brain Stimulation Treatments for Drug-Resistant Epilepsy. Cureus 2016; 8:e744. [PMID: 27672534 PMCID: PMC5035081 DOI: 10.7759/cureus.744] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Many post-traumatic epilepsy (PTE) patients become resistant to medications. Nervous stimulation as a treatment for drug-resistant epilepsy (DRE) is an active area of clinical investigation. Objective: To summarize methods, reported seizure control outcome measures, and adverse events from blinded, randomized control trials (RCTs) for selected invasive brain stimulation (IBS) and non-invasive brain stimulation (NIBS) treatment options in patients with DRE. Methods: PubMed was searched for articles from 1995-2014, using search terms related to the topics of interest. Available relevant articles reporting the outcomes of interest were identified and data was extracted. Articles in the reference lists of relevant articles and clinicaltrials.gov were also referenced. Results: Eleven articles were analyzed with a total of 795 patients identified. Studies showed that select nervous stimulation treatments significantly reduced seizure frequency in patients with DRE.
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Affiliation(s)
- Michael Larkin
- School of Medicine, Uniformed Services University of the Health Sciences
| | - R Michael Meyer
- School of Medicine, Uniformed Services University of the Health Sciences
| | | | - Meryl A Severson
- Department of Neurosurgery, Walter Reed National Military Medical Center/Uniformed Services University of Health Sciences
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Abstract
BACKGROUND Epilepsy is a highly prevalent neurological condition characterized by repeated unprovoked seizures with various etiologies. Although antiepileptic medications produce clinical improvement in most individuals, nearly a third of individuals have drug-resistant epilepsy that carries significant morbidity and mortality. There remains a need for non-invasive and more effective therapies for this population. Transcranial magnetic stimulation (TMS) uses electromagnetic coils to excite or inhibit neurons, with repetitive pulses at low-frequency producing an inhibitory effect that could conceivably reduce cortical excitability associated with epilepsy. OBJECTIVES To assess the evidence for the use of TMS in individuals with drug-resistant epilepsy compared with other available treatments in reducing seizure frequency, improving quality of life, reducing epileptiform discharges, antiepileptic medication use, and side-effects. SEARCH METHODS We searched the Cochrane Epilepsy Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online (CRSO), MEDLINE (Ovid 1946 to 10 March 2016), ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (ICTRP) up to March 2016. We also searched SCOPUS (1823 to June 2014) as a substitute for Embase (but it is no longer necessary to search SCOPUS, because randomized controlled trials (RCTs) and quasi-RCTs in EMBASE are now included in CENTRAL). SELECTION CRITERIA Eligible studies were RCTs that were double-blinded, single-blinded or unblinded, and placebo, no treatment, or active controlled, which used repetitive transcranial magnetic stimulation (rTMS) without restriction of frequency, duration, intensity, or setup (focal or vertex treatment) on patients with drug-resistant epilepsy. The search revealed 274 records from the databases, that after selection provided seven full-text relevant studies for inclusion. Of the seven studies included, five were completed studies with published data and included randomized, blinded trials. The total number of participants in the seven trials was 230. DATA COLLECTION AND ANALYSIS We extracted information from each trial including methodological data; participant demographics including baseline seizure frequency, type of epileptic drugs taken; intervention details and intervention groups for comparison; potential biases; and outcomes and time points, primarily change in seizure frequency or responder rates, as well as quality of life and epileptiform discharges, adverse effects, and changes in medication use. MAIN RESULTS Two of the seven studies analyzed showed a statistically significant reduction in seizure rate from baseline (72% and 78.9% reduction of seizures per week from the baseline rate, respectively). The other five studies showed no statistically significant difference in seizure frequency following rTMS treatment compared with controls. We were not able to combine the results of the trials in analysis due to differences in the designs of the studies. Four studies evaluated our secondary endpoint of mean number of epileptic discharges, and three of the four showed a statistically significant reduction in discharges. Quality of life was not assessed in any of the studies. Adverse effects were uncommon among the studies and typically involved headache, dizziness, and tinnitus. No significant changes in medication use were found in the trials. AUTHORS' CONCLUSIONS Overall, we judged the quality of evidence for the primary outcomes of this review to be low. There is evidence that rTMS is safe and not associated with any adverse events, but given the variability in technique and outcome reporting that prevented meta-analysis, the evidence for efficacy of rTMS for seizure reduction is still lacking despite reasonable evidence that it is effective at reducing epileptiform discharges.
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Affiliation(s)
- Ricky Chen
- Clinical Neurosciences Center, University of Utah, Department of Neurology, 175 North Medical Drive East, Salt Lake City, Utah, USA, 84132
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Carrette S, Boon P, Dekeyser C, Klooster DCW, Carrette E, Meurs A, Raedt R, Baeken C, Vanhove C, Aldenkamp AP, Vonck K. Repetitive transcranial magnetic stimulation for the treatment of refractory epilepsy. Expert Rev Neurother 2016; 16:1093-110. [DOI: 10.1080/14737175.2016.1197119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pereira LS, Müller VT, da Mota Gomes M, Rotenberg A, Fregni F. Safety of repetitive transcranial magnetic stimulation in patients with epilepsy: A systematic review. Epilepsy Behav 2016; 57:167-176. [PMID: 26970993 DOI: 10.1016/j.yebeh.2016.01.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/13/2016] [Accepted: 01/15/2016] [Indexed: 11/17/2022]
Abstract
Approximately one-third of patients with epilepsy remain with pharmacologically intractable seizures. An emerging therapeutic modality for seizure suppression is repetitive transcranial magnetic stimulation (rTMS). Despite being considered a safe technique, rTMS carries the risk of inducing seizures, among other milder adverse events, and thus, its safety in the population with epilepsy should be continuously assessed. We performed an updated systematic review on the safety and tolerability of rTMS in patients with epilepsy, similar to a previous report published in 2007 (Bae EH, Schrader LM, Machii K, Alonso-Alonso M, Riviello JJ, Pascual-Leone A, Rotenberg A. Safety and tolerability of repetitive transcranial magnetic stimulation in patients with epilepsy: a review of the literature. Epilepsy Behav. 2007; 10 (4): 521-8), and estimated the risk of seizures and other adverse events during or shortly after rTMS application. We searched the literature for reports of rTMS being applied on patients with epilepsy, with no time or language restrictions, and obtained studies published from January 1990 to August 2015. A total of 46 publications were identified, of which 16 were new studies published after the previous safety review of 2007. We noted the total number of subjects with epilepsy undergoing rTMS, medication usage, incidence of adverse events, and rTMS protocol parameters: frequency, intensity, total number of stimuli, train duration, intertrain intervals, coil type, and stimulation site. Our main data analysis included separate calculations for crude per subject risk of seizure and other adverse events, as well as risk per 1000 stimuli. We also performed an exploratory, secondary analysis on the risk of seizure and other adverse events according to the type of coil used (figure-of-8 or circular), stimulation frequency (≤ 1 Hz or > 1 Hz), pulse intensity in terms of motor threshold (<100% or ≥ 100%), and number of stimuli per session (< 500 or ≥ 500). Presence or absence of adverse events was reported in 40 studies (n = 426 subjects). A total of 78 (18.3%) subjects reported adverse events, of which 85% were mild. Headache or dizziness was the most common one, occurring in 8.9%. We found a crude per subject seizure risk of 2.9% (95% CI: 1.3-4.5), given that 12 subjects reported seizures out of 410 subjects included in the analysis after data of patients with epilepsia partialis continua or status epilepticus were excluded from the estimate. Only one of the reported seizures was considered atypical in terms of the clinical characteristics of the patients' baseline seizures. The atypical seizure happened during high-frequency rTMS with maximum stimulator output for speech arrest, clinically arising from the region of stimulation. Although we estimated a larger crude per subject seizure risk compared with the previous safety review, the corresponding confidence intervals contained both risks. Furthermore, the exclusive case of atypical seizure was the same as reported in the previous report. We conclude that the risk of seizure induction in patients with epilepsy undergoing rTMS is small and that the risk of other adverse events is similar to that of rTMS applied to other conditions and to healthy subjects. Our results should be interpreted with caution, given the need for adjusted analysis controlling for potential confounders, such as baseline seizure frequency. The similarity between the safety profiles of rTMS applied to the population with epilepsy and to individuals without epilepsy supports further investigation of rTMS as a therapy for seizure suppression.
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Affiliation(s)
- Luisa Santos Pereira
- Spaulding Neuromodulation Center, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Vanessa Teixeira Müller
- Institute of Neurology Deolindo Couto, Federal University of Rio de Janeiro, RJ 22290-140, Brazil
| | - Marleide da Mota Gomes
- Institute of Neurology Deolindo Couto, Federal University of Rio de Janeiro, RJ 22290-140, Brazil
| | - Alexander Rotenberg
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Felipe Fregni
- Spaulding Neuromodulation Center, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02129, USA.
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Klooster DCW, de Louw AJA, Aldenkamp AP, Besseling RMH, Mestrom RMC, Carrette S, Zinger S, Bergmans JWM, Mess WH, Vonck K, Carrette E, Breuer LEM, Bernas A, Tijhuis AG, Boon P. Technical aspects of neurostimulation: Focus on equipment, electric field modeling, and stimulation protocols. Neurosci Biobehav Rev 2016; 65:113-41. [PMID: 27021215 DOI: 10.1016/j.neubiorev.2016.02.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 02/05/2016] [Accepted: 02/17/2016] [Indexed: 12/31/2022]
Abstract
Neuromodulation is a field of science, medicine, and bioengineering that encompasses implantable and non-implantable technologies for the purpose of improving quality of life and functioning of humans. Brain neuromodulation involves different neurostimulation techniques: transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), which are being used both to study their effects on cognitive brain functions and to treat neuropsychiatric disorders. The mechanisms of action of neurostimulation remain incompletely understood. Insight into the technical basis of neurostimulation might be a first step towards a more profound understanding of these mechanisms, which might lead to improved clinical outcome and therapeutic potential. This review provides an overview of the technical basis of neurostimulation focusing on the equipment, the present understanding of induced electric fields, and the stimulation protocols. The review is written from a technical perspective aimed at supporting the use of neurostimulation in clinical practice.
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Affiliation(s)
- D C W Klooster
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - A J A de Louw
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - A P Aldenkamp
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - R M H Besseling
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - R M C Mestrom
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - S Carrette
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - S Zinger
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - J W M Bergmans
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - W H Mess
- Departments of Clinical Neurophysiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - K Vonck
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - E Carrette
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - L E M Breuer
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands.
| | - A Bernas
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - A G Tijhuis
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - P Boon
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
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32
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Seynaeve L, Devroye A, Dupont P, Van Paesschen W. Randomized crossover sham-controlled clinical trial of targeted low-frequency transcranial magnetic stimulation comparing a figure-8 and a round coil to treat refractory neocortical epilepsy. Epilepsia 2015; 57:141-50. [DOI: 10.1111/epi.13247] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Laura Seynaeve
- Department of Neurology; Laboratory for Epilepsy Research; University Hospitals & KU Leuven; Leuven Belgium
| | - Annemie Devroye
- Department of Neurology; Laboratory for Epilepsy Research; University Hospitals & KU Leuven; Leuven Belgium
| | - Patrick Dupont
- Department of Neurology; Laboratory for Epilepsy Research; University Hospitals & KU Leuven; Leuven Belgium
- Laboratory for Cognitive Neurology; KU Leuven; Leuven Belgium
| | - Wim Van Paesschen
- Department of Neurology; Laboratory for Epilepsy Research; University Hospitals & KU Leuven; Leuven Belgium
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33
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Enke AM, St Louis E, Jackson CF, Makin SM. Non-pharmacological treatments for improving memory in people with epilepsy. Hippokratia 2015. [DOI: 10.1002/14651858.cd011945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ashley M Enke
- Mayo Clinic and Foundation; Department of Sleep Medicine; 200 First Street Southwest Rochester Minnesota USA 55905
| | - Erik St Louis
- Mayo Clinic and Foundation; Neurology and Medicine; 200 First Street Southwest Rochester Minnesota USA 55905
| | - Cerian F Jackson
- Institute of Translational Medicine, University of Liverpool; Department of Molecular and Clinical Pharmacology; Clinical Sciences Centre for Research and Education, Lower Lane Fazakerley Liverpool UK L9 7LJ
| | - Selina M Makin
- The Walton Centre NHS Foundation Trust; Lower Lane Fazakerley Liverpool UK L9 7LJ
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Incecik F, Horoz OO, Herguner OM, Yıldızdas D, Altunbasak S. Electroconvulsive therapy for refractory status epilepticus in a child: A case report. Ann Indian Acad Neurol 2015; 18:364-5. [PMID: 26425029 PMCID: PMC4564486 DOI: 10.4103/0972-2327.157250] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Faruk Incecik
- Department of Pediatric Neurology, Cukurova University, Faculty of Medicine, Adana, Turkey
| | - Ozden O Horoz
- Department of Pediatric Intensive Care Unit, Cukurova University, Faculty of Medicine, Adana, Turkey
| | - Ozlem M Herguner
- Department of Pediatric Neurology, Cukurova University, Faculty of Medicine, Adana, Turkey
| | - Dincer Yıldızdas
- Department of Pediatric Intensive Care Unit, Cukurova University, Faculty of Medicine, Adana, Turkey
| | - Sakir Altunbasak
- Department of Pediatric Neurology, Cukurova University, Faculty of Medicine, Adana, Turkey
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Moradi Chameh H, Janahmadi M, Semnanian S, Shojaei A, Mirnajafi-Zadeh J. Effect of low frequency repetitive transcranial magnetic stimulation on kindling-induced changes in electrophysiological properties of rat CA1 pyramidal neurons. Brain Res 2015; 1606:34-43. [DOI: 10.1016/j.brainres.2015.02.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/10/2015] [Accepted: 02/13/2015] [Indexed: 12/29/2022]
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Abstract
Epilepsy afflicts approximately 1-2% of the world's population. The mainstay therapy for treating the chronic recurrent seizures that are emblematic of epilepsy are drugs that manipulate levels of neuronal excitability in the brain. However, approximately one-third of all epilepsy patients get little to no clinical relief from this therapeutic regimen. The use of electrical stimulation in many forms to treat drug-refractory epilepsy has grown markedly over the past few decades, with some devices and protocols being increasingly used as standard clinical treatment. This article seeks to review the fundamental modes of applying electrical stimulation-from the noninvasive to the nominally invasive to deep brain stimulation-for the control of seizures in epileptic patients. Therapeutic practices from the commonly deployed clinically to the experimental are discussed to provide an overview of the innovative neural engineering approaches being explored to treat this difficult disease.
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Affiliation(s)
- David J Mogul
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois 60616;
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Shojaei A, Semnanian S, Janahmadi M, Moradi-Chameh H, Firoozabadi S, Mirnajafi-Zadeh J. Repeated transcranial magnetic stimulation prevents kindling-induced changes in electrophysiological properties of rat hippocampal CA1 pyramidal neurons. Neuroscience 2014; 280:181-92. [DOI: 10.1016/j.neuroscience.2014.09.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 09/10/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023]
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Abstract
ABSTRACT The use of devices in the treatment of epilepsy is an emerging therapy for those patients whose seizures are not controlled by medications. This article will discuss current treatment options with devices for vagus nerve stimulation, deep brain stimulation and responsive neurostimulation. Emerging therapies in noninvasive neurostimulation such as with trigeminal nerve stimulation, transcranial magnetic stimulation and transcranial direct current stimulation may prove to be promising solutions. Finally, new and enhanced techniques of drug delivery are discussed as well as other devices with potential use in the study and treatment of epilepsy.
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Affiliation(s)
- Amanda F Van Straten
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Barbara C Jobst
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH 03756, USA
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Abstract
Non pharmacological treatment, in addition to pharmacological treatment is indicated in patients with refractory/pharmacoresistant epilepsy and includes ketogenic diet, deep brain stimulator, vagal nerve stimulator, transcranial magnetic stimulation and epilepsy surgery. Ketogenic diet has been recommended since 1921 and has been proved to be a safe and effective treatment for intractable epilepsy. Deep brain stimulator, has been used in the treatment of movement disorders for many years and recently been tried in the treatment of pharmacoresistant epilepsy. Vagus nerve stimulator is increasingly being used as an effective seizure aborting technique in patients not responding to anticonvulsants. Transcranial magnetic stimulation is a noninvasive brain stimulation technique which is being increasingly researched for use in patients with medication-refractory seizures who are not suitable candidates for surgery. Evolution of epilepsy surgery including Vagal nerve stimulator and Deep brain stimulator, as a successful treatment modality for intractable epilepsy has been influenced over the last decade by substantial advancement in imaging and operative/device related technology. The current article reviews the indications, mechanism of action, technological aspects and efficacy of the aforementioned modalities in the treatment of intractable/pharmacoresistant epilepsy in pediatric age group.
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Lefaucheur JP, André-Obadia N, Antal A, Ayache SS, Baeken C, Benninger DH, Cantello RM, Cincotta M, de Carvalho M, De Ridder D, Devanne H, Di Lazzaro V, Filipović SR, Hummel FC, Jääskeläinen SK, Kimiskidis VK, Koch G, Langguth B, Nyffeler T, Oliviero A, Padberg F, Poulet E, Rossi S, Rossini PM, Rothwell JC, Schönfeldt-Lecuona C, Siebner HR, Slotema CW, Stagg CJ, Valls-Sole J, Ziemann U, Paulus W, Garcia-Larrea L. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol 2014; 125:2150-2206. [PMID: 25034472 DOI: 10.1016/j.clinph.2014.05.021] [Citation(s) in RCA: 1249] [Impact Index Per Article: 124.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/09/2014] [Accepted: 05/13/2014] [Indexed: 12/11/2022]
Abstract
A group of European experts was commissioned to establish guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) from evidence published up until March 2014, regarding pain, movement disorders, stroke, amyotrophic lateral sclerosis, multiple sclerosis, epilepsy, consciousness disorders, tinnitus, depression, anxiety disorders, obsessive-compulsive disorder, schizophrenia, craving/addiction, and conversion. Despite unavoidable inhomogeneities, there is a sufficient body of evidence to accept with level A (definite efficacy) the analgesic effect of high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the pain and the antidepressant effect of HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC). A Level B recommendation (probable efficacy) is proposed for the antidepressant effect of low-frequency (LF) rTMS of the right DLPFC, HF-rTMS of the left DLPFC for the negative symptoms of schizophrenia, and LF-rTMS of contralesional M1 in chronic motor stroke. The effects of rTMS in a number of indications reach level C (possible efficacy), including LF-rTMS of the left temporoparietal cortex in tinnitus and auditory hallucinations. It remains to determine how to optimize rTMS protocols and techniques to give them relevance in routine clinical practice. In addition, professionals carrying out rTMS protocols should undergo rigorous training to ensure the quality of the technical realization, guarantee the proper care of patients, and maximize the chances of success. Under these conditions, the therapeutic use of rTMS should be able to develop in the coming years.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France.
| | - Nathalie André-Obadia
- Neurophysiology and Epilepsy Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Bron, France; Inserm U 1028, NeuroPain Team, Neuroscience Research Center of Lyon (CRNL), Lyon-1 University, Bron, France
| | - Andrea Antal
- Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany
| | - Samar S Ayache
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium
| | - David H Benninger
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Roberto M Cantello
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale "A. Avogadro", Novara, Italy
| | | | - Mamede de Carvalho
- Institute of Physiology, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal
| | - Dirk De Ridder
- Brai(2)n, Tinnitus Research Initiative Clinic Antwerp, Belgium; Department of Neurosurgery, University Hospital Antwerp, Belgium
| | - Hervé Devanne
- Department of Clinical Neurophysiology, Lille University Hospital, Lille, France; ULCO, Lille-Nord de France University, Lille, France
| | - Vincenzo Di Lazzaro
- Department of Neurosciences, Institute of Neurology, Campus Bio-Medico University, Rome, Italy
| | - Saša R Filipović
- Department of Neurophysiology, Institute for Medical Research, University of Belgrade, Beograd, Serbia
| | - Friedhelm C Hummel
- Brain Imaging and Neurostimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Satu K Jääskeläinen
- Department of Clinical Neurophysiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Giacomo Koch
- Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Thomas Nyffeler
- Perception and Eye Movement Laboratory, Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Emmanuel Poulet
- Department of Emergency Psychiatry, CHU Lyon, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; EAM 4615, Lyon-1 University, Bron, France
| | - Simone Rossi
- Brain Investigation & Neuromodulation Lab, Unit of Neurology and Clinical Neurophysiology, Department of Neuroscience, University of Siena, Siena, Italy
| | - Paolo Maria Rossini
- Brain Connectivity Laboratory, IRCCS San Raffaele Pisana, Rome, Italy; Institute of Neurology, Catholic University, Rome, Italy
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | | | - Hartwig R Siebner
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Charlotte J Stagg
- Oxford Centre for Functional MRI of the Brain (FMRIB), Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Josep Valls-Sole
- EMG Unit, Neurology Service, Hospital Clinic, Department of Medicine, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
| | - Walter Paulus
- Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany
| | - Luis Garcia-Larrea
- Inserm U 1028, NeuroPain Team, Neuroscience Research Center of Lyon (CRNL), Lyon-1 University, Bron, France; Pain Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Bron, France
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41
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Kamida T, Kong S, Eshima N, Fujiki M. Cathodal transcranial direct current stimulation affects seizures and cognition in fully amygdala-kindled rats. Neurol Res 2013; 35:602-7. [PMID: 23562065 DOI: 10.1179/1743132813y.0000000170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study evaluated the effects of weak transcranial direct current stimulation (tDCS), a new non-invasive brain stimulation technique, on amygdala-kindled rats. The seizure severity, i.e. seizure stage, afterdischarge duration (ADD), and AD threshold (ADT) in the animals were measured one day after the last cathodal tDCS session, comparing with those of pre-treatment controls. Furthermore, the effects of cathodal tDCS on cognitive function were also studied by a water maze test (WMT) two days after the last tDCS session. Cathodal tDCS treatment significantly improved the seizure stage and decreased ADD together with elevated ADT one day after the last tDCS session. The treatment also showed significant improvement in the performance of WMT. The findings suggest that cathodal tDCS has anticonvulsive after-effects last at least for one day on the amygdala-kindled rats and positively affects cognitive performance.
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Affiliation(s)
- Tohru Kamida
- Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
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42
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Liu A, Fregni F, Hummel F, Pascual-Leone A. Therapeutic Applications of Transcranial Magnetic Stimulation/Transcranial Direct Current Stimulation in Neurology. TRANSCRANIAL BRAIN STIMULATION 2012. [DOI: 10.1201/b14174-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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43
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Abstract
The role of transcranial magnetic stimulation in epileptology is discussed in this article. Usefulness of TMS are discussed as a diagnostic tool in testing altered cortical excitability in patients with epilepsy and the modes of action of antiepileptic drugs, which are helpful to evaluate the pathophysiology of epilepsy. Also potential therapeutic tool in epilepsy with repetitive transcranial magnetic stimulation would be mentioned.
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Affiliation(s)
- Eun Yeon Joo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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44
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Sun W, Mao W, Meng X, Wang D, Qiao L, Tao W, Li L, Jia X, Han C, Fu M, Tong X, Wu X, Wang Y. Low-frequency repetitive transcranial magnetic stimulation for the treatment of refractory partial epilepsy: A controlled clinical study. Epilepsia 2012; 53:1782-9. [DOI: 10.1111/j.1528-1167.2012.03626.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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45
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Nojima K, Ge S, Katayama Y, Iramina K. Relationship between pulse number of rTMS and inter reversal time of perceptual reversal. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2011:8106-9. [PMID: 22256223 DOI: 10.1109/iembs.2011.6091999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of this study is to investigate the stimulus parameter which affects the repetitive Transcranial Magnetic Stimulation (rTMS) effect. It is said that the condition under 1Hz rTMS induces the inhibition effect. On the other hand, the condition over 1 Hz rTMS induces the facilitation effect. However the number of pulses of rTMS is also important factor. In this study, we focused on the number of pulses. We used the cognitive task of perceptual reversal and compared the rTMS effects of different condition under 1 Hz which is the inhibition condition. It has been known that the right superior parietal lobule (SPL) has a role in perceptual reversal. We applied rTMS over the SPL and measured the inter-reversal time (IRT) of perceptual reversal. The results showed that when 0.25 Hz 60 pulses, 0.5 Hz 60 pulses and 1 Hz 60 pulses of rTMS was applied over the right SPL, the IRT was significantly smaller. On the other hand, when 1 Hz 240 pulses of rTMS was applied over the right SPL, the IRT was significantly longer. When 0.25 Hz 12 0 pulses, 0.5 Hz 120 pulses and 1Hz 120 pulses of rTMS was applied over the right SPL, there were no significant differences. Furthermore, to investigate the rTMS effects, when rTMS are applied over the motor area, we measured the motor evoked potential (MEP). The more pulses of rTMS was applied, the smaller the amplitude of MEP became. From these results, it was found that the IRT of perceptual reversal and the amplitude of MEP primarily affected by the number of pulses of rTMS.
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Affiliation(s)
- K Nojima
- Graduate School of Systems Life Sciences, Kyushu University, 744 Motooka Nishi-ku, Fukuoka 819-0395, Japan.
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46
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Lefaucheur JP, André-Obadia N, Poulet E, Devanne H, Haffen E, Londero A, Cretin B, Leroi AM, Radtchenko A, Saba G, Thai-Van H, Litré CF, Vercueil L, Bouhassira D, Ayache SS, Farhat WH, Zouari HG, Mylius V, Nicolier M, Garcia-Larrea L. [French guidelines on the use of repetitive transcranial magnetic stimulation (rTMS): safety and therapeutic indications]. Neurophysiol Clin 2011; 41:221-95. [PMID: 22153574 DOI: 10.1016/j.neucli.2011.10.062] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 10/18/2011] [Indexed: 12/31/2022] Open
Abstract
During the past decade, a large amount of work on transcranial magnetic stimulation (TMS) has been performed, including the development of new paradigms of stimulation, the integration of imaging data, and the coupling of TMS techniques with electroencephalography or neuroimaging. These accumulating data being difficult to synthesize, several French scientific societies commissioned a group of experts to conduct a comprehensive review of the literature on TMS. This text contains all the consensual findings of the expert group on the mechanisms of action, safety rules and indications of TMS, including repetitive TMS (rTMS). TMS sessions have been conducted in thousands of healthy subjects or patients with various neurological or psychiatric diseases, allowing a better assessment of risks associated with this technique. The number of reported side effects is extremely low, the most serious complication being the occurrence of seizures. In most reported seizures, the stimulation parameters did not follow the previously published recommendations (Wassermann, 1998) [430] and rTMS was associated to medication that could lower the seizure threshold. Recommendations on the safe use of TMS / rTMS were recently updated (Rossi et al., 2009) [348], establishing new limits for stimulation parameters and fixing the contraindications. The recommendations we propose regarding safety are largely based on this previous report with some modifications. By contrast, the issue of therapeutic indications of rTMS has never been addressed before, the present work being the first attempt of a synthesis and expert consensus on this topic. The use of TMS/rTMS is discussed in the context of chronic pain, movement disorders, stroke, epilepsy, tinnitus and psychiatric disorders. There is already a sufficient level of evidence of published data to retain a therapeutic indication of rTMS in clinical practice (grade A) in chronic neuropathic pain, major depressive episodes, and auditory hallucinations. The number of therapeutic indications of rTMS is expected to increase in coming years, in parallel with the optimisation of stimulation parameters.
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Affiliation(s)
- J-P Lefaucheur
- EA 4391, faculté de médecine, université Paris-Est-Créteil, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
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Hsu WY, Cheng CH, Lin MW, Shih YH, Liao KK, Lin YY. Antiepileptic effects of low frequency repetitive transcranial magnetic stimulation: A meta-analysis. Epilepsy Res 2011; 96:231-40. [DOI: 10.1016/j.eplepsyres.2011.06.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 05/13/2011] [Accepted: 06/05/2011] [Indexed: 10/18/2022]
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Abstract
Patients with medically intractable epilepsy who are not candidates for epilepsy surgery could benefit from neurostimulation. At this time, vagus nerve stimulation (VNS) therapy is the only Food and Drug Administation-approved neurostimulation modality; it has been shown to be efficacious and just as well tolerated in children and adolescents as in adults. Notwithstanding the initial cost of the device and implantation, VNS therapy has been shown to be a cost-effective treatment, reducing direct medical costs and improving health-related quality of life measures. Deep brain stimulation of various brain regions, especially the anterior nucleus of the thalamus and responsive neurostimulation, also appear effective but are not yet approved for clinical use. Repetitive transcranial magnetic stimulation, which is also in early clinical development, is promising and could become available in the not too distant future.
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49
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Mani R, Pollard J, Dichter MA. Human clinical trails in antiepileptogenesis. Neurosci Lett 2011; 497:251-6. [PMID: 21439351 DOI: 10.1016/j.neulet.2011.03.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 03/01/2011] [Accepted: 03/02/2011] [Indexed: 01/11/2023]
Abstract
Blocking the development of epilepsy (epileptogenesis) is a fundamental research area with the potential to provide large benefits to patients by avoiding the medical and social consequences that occur with epilepsy and lifelong therapy. Human clinical trials attempting to prevent epilepsy (antiepileptogenesis) have been few and universally unsuccessful to date. In this article, we review data about possible pathophysiological mechanisms underlying epileptogenesis, discuss potential interventions, and summarize prior antiepileptogenesis trials. Elements of ideal trials designs for successful antiepileptogenic intervention are suggested.
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Affiliation(s)
- Ram Mani
- Department of Neurology, University of Pennsylvania, United States
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50
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Bae EH, Theodore WH, Fregni F, Cantello R, Pascual-Leone A, Rotenberg A. An estimate of placebo effect of repetitive transcranial magnetic stimulation in epilepsy. Epilepsy Behav 2011; 20:355-9. [PMID: 21216200 PMCID: PMC3059584 DOI: 10.1016/j.yebeh.2010.12.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 11/30/2010] [Accepted: 12/01/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Low-frequency repetitive transcranial magnetic stimulation (rTMS) is emerging as a therapeutic tool in epilepsy. In recent years, several open-label trials have shown an encouraging reduction in seizure frequency in patients with epilepsy. However, the data from controlled trials are mixed with respect to antiepileptic rTMS efficacy, and the field would benefit from further carefully controlled trials. Prior to initiating new trials, it is important assess the magnitude of the placebo effect of presently used sham rTMS methods. METHODS We systematically analyzed individual subject data from three placebo-controlled trials and measured the placebo effect at follow-up intervals of 2, 4, and 8 weeks after sham rTMS treatment. Given the relatively small subgroup sample size, placebo condition data were pooled for analysis. RESULTS Three methods for sham rTMS were employed in the reviewed studies: (1) coil positioning orthogonal to the scalp, (2) a spring-loaded sham coil, and (3) a double active-sham coil. The placebo response overall was consistently low across follow-up intervals, both for median change in seizure frequency (Kruskal-Wallis, P>0.4, df=2) and for responder (defined as ≥ 50% seizure frequency reduction) rate (Fisher's exact rest, P>0.9, df=2). The aggregate effect of the placebo condition was a 0-2% median seizure reduction rate and a responder rate of 16-20%. CONCLUSION We anticipate that these data will contribute to future power analysis as well as selection and design of sham rTMS methods for controlled rTMS trials.
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Affiliation(s)
- Erica Hyunji Bae
- Department of Neurology, Children's Hospital, Harvard Medical School, Boston, MA, USA,Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Felipe Fregni
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Roberto Cantello
- Department of Clinical and Experimental Medicine, Section of Neurology, Amedeo Avogadro University, Novara, Italy
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alexander Rotenberg
- Department of Neurology, Children's Hospital, Harvard Medical School, Boston, MA, USA,Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,Corresponding author. Department of Neurology, Harvard Medical School, Children's Hospital, Boston, MA 02115, USA. Fax: +1 617 730 0463. (A. Rotenberg)
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