Repetitive transcranial magnetic stimulation for epilepsy: Efficacy and safety

Repetitive transcranial magnetic stimulation (rTMS) is a safe and tolerable technique with significant therapeutic potential for neurological disorders, extensively studied in recent decades. Epilepsy has been a major focus of this research, particularly low-frequency rTMS. Recent reports, clinical trials, and reviews have presented conflicting evidence on its efficacy and side effects. This review, examining studies published from January 1999 to January 2026, specifically evaluates the efficacy and side effects of rTMS for epilepsy. This study not only compares the sample size of the reviewed articles but also provides a more multifaceted examination and more comprehensive clinical approaches. Our findings indicate promising clinical applications of rTMS in epilepsy. The technique demonstrates the ability to reduce interictal epileptic abnormalities while showing a favorable safety profile: it does not interfere with neuropsychological function in healthy individuals, does not worsen cognitive function (even improving Stroop function), and rarely causes serious side effects like seizures or psychotic symptoms. It shows low risk in both children and adults and holds potential for improving suicidal ideation. This review suggests that rTMS holds considerable potential for mitigating epilepsy-related complications, and the reported side effects appear to be infrequent. Based on these findings, we advocate for the continued investigation and clinical exploration of rTMS as a valuable adjunctive tool. (PROSPERO ID CRD420261417594).