Transcranial Magnetic Stimulation for Status Epilepticus

Area of Science:

• Neurology
• Neuroscience
• Clinical Medicine

Background:

• Status epilepticus (SE) and refractory status epilepticus (RSE) are severe neurological emergencies.
• Current treatment options for RSE have limitations, necessitating exploration of novel therapeutic approaches.

Purpose of the Study:

• To systematically review the existing literature on the efficacy of repetitive transcranial magnetic stimulation (rTMS) for treating SE and RSE.
• To assess the strength of evidence supporting rTMS as a treatment modality for these conditions.

Main Methods:

• A comprehensive search of multiple electronic databases and clinical trial registries was conducted.
• Included studies were evaluated using the Oxford and GRADE methodologies to determine the strength of evidence.
• Data from 11 retrospective studies involving 21 patients (13 adults, 8 pediatric) were analyzed.

Main Results:

• Repetitive transcranial magnetic stimulation (rTMS) resulted in seizure reduction or control in 15 out of 21 patients (71.4%).
• Partial and complete seizure responses were observed in 23.8% and 47.6% of patients, respectively.
• A significant limitation was the short-lived effect, with seizure recurrence in 73.3% of responders.

Conclusions:

• Limited evidence (Oxford level 4, GRADE D) suggests rTMS may offer temporary seizure control in SE and RSE.
• The durability of therapeutic effects is short, precluding current recommendations for routine use.
• Further high-quality prospective studies are essential to validate the potential role of rTMS in managing SE and RSE.