Continuous theta burst stimulation for drug-resistant epilepsy

Area of Science:

• Neuroscience
• Neurology
• Epileptology

Background:

• Repetitive transcranial magnetic stimulation (rTMS) has shown potential anti-epileptic effects, particularly for neocortical lesions.
• Conventional rTMS effects are often short-lived, necessitating more durable treatment options for chronic conditions like epilepsy.
• Theta burst stimulation (TBS) offers potential for longer-lasting after-effects and improved treatment practicality compared to standard rTMS.

Purpose of the Study:

• To evaluate the safety and feasibility of a 4-day accelerated continuous theta burst stimulation (cTBS) protocol in patients with neocortical drug-resistant epilepsy (DRE).
• To assess seizure frequency as a secondary outcome in patients undergoing the novel cTBS treatment.

Main Methods:

• A prospective, open-label pilot study involving seven patients with neocortical DRE.
• Administered a 4-day accelerated cTBS protocol targeting the epileptic focus (EF) using neuronavigation.
• Assessed safety, feasibility, seizure frequency, cognitive function, and psycho-emotional well-being over baseline, treatment, and follow-up periods.

Main Results:

• The cTBS protocol was found to be safe and feasible, with all adverse events being mild and transient.
• No seizures were evoked during or immediately after stimulation, and no cognitive or psycho-emotional deterioration was observed.
• Median weekly seizure frequency and the ratio of seizure-free weeks did not show significant changes in this small cohort.

Conclusions:

• This study reports the first trial of cTBS for neocortical DRE, demonstrating its safety and feasibility.
• While not powered to confirm efficacy, the results support further investigation of cTBS as an anti-epileptic treatment.
• Future randomized controlled trials are warranted to compare cTBS with conventional rTMS for epilepsy treatment.