Low-frequency repetitive transcranial magnetic stimulation improves intractable epilepsy

In this open pilot study, we investigated the effects of lowfrequency rTMS in nine patients (21‐48 years, five women) with medically refractory focal epilepsies (two temporal, seven extratemporal) with very frequent partial and secondary generalised seizures. Even under various first-line and second-line antiepileptic drugs, more than seven seizures per week on average had occurred during 6 months at least before this investigation and surgical intervention had been ruled out. All patients gave written informed consent to take part in the study, which was approved by the local ethics committee. rTMS was done on 5 consecutive days. On each study day, two trains of 500 pulses from a repetitive magnetic stimulator (Dantec, Denmark) were applied by means of a round coil (9 cm diameter) placed over the vertex. rTMS frequency was 0·33 Hz. 4 weeks before and after the treatment, patients were requested to record every definite seizure or any seizure-like event. Every observation (partial seizure with or without secondary generalisation) was counted as a seizure and, for analysis, epilepsy was assessed by the calculated number of seizures per week. During the study period, medication was kept constant.