H-coil repetitive transcranial magnetic stimulation for treatment of temporal lobe epilepsy: A case report

Background:

Low frequency repetitive TMS (rTMS) of a cortical seizure focus is emerging as an antiepileptic treatment. While conventional rTMS stimulators activate only superficialcortical areas, reaching deep epileptic foci, for example in temporal lobe epilepsy (TLE), is possible using specially designed H-coils.

Objective:

This study reports the results of rTMS in a young adult with pharmacoresistant bilateral TLE.

Methods:

The patient underwent three courses (of 10, 15, and 30 daily sessions) of unilateral rTMS over the hemisphere from which seizures originated most often. Seizure frequency was assessed before and after each block of rTMS sessions, as was the tolerability ofthe procedure.

Results:

Following each rTMS course, a 50–70% reduction in number of single seizures was found(p = 0.003, p = 0.001, and p = 0.013 following first, second, and third rTMS course, respectively) as well as a reduction intotal number of seizures (p = 0.001 following all 3 rTMS courses). The number of clusters was reduced significantly after the first (p = 0.001), and clusters were absent after the third (p = 0.001) rTMS session. In addition, following the first (but not second or third) rTMS course, a gradual relapse was found in the number of clusters (p = 0.017) and total number of seizures (p = 0.016) suggesting a more sustained anti-seizure effect of the second and third treatments.

Conclusions:

In addition to documenting seizure improvement in TLE after H-coil rTMS, thisstudy may be the first to report serial rTMS in a patient with epilepsy, in this case with progressive increases in relative intensity and duration rTMS protocols.