Clinical and electrophysiological effects of theta burst magnetic stimulation on seizures

Objective: The aim of this study was to evaluate the effect of 30 Hz cTBS on seizure frequency and EEG in treatment-refractory generalized and focal epilepsies. Secondary efficacy measures were to review potential side effects of TBS, to evaluate psychosocial and behavioral problems with Symptom Checlist -90 (SCL-90), and to evaluate effects on quality of life with QOLIE 89. Methods: Twelve patients with generalized and focal seizures and refractory epilepsy according to ILAE 2010 recommendation were included in the study. TMS applications were randomized as group 1 = active, group 2 = placebo stimulation. As active stimulation, 80% of Resting motor threshold (RMT), 30 Hz, total 600 pulses of TBS were applied for 5 days. For placebo stimulation, the same stimulation was administered by placing the coil 90 degrees perpendicular to the head. The patients were followed up for 8-12 weeks before and after stimulation. EEG recordings were performed before TBS treatment, at the 5th day after the treatment and at 1 month and 2 months during the follow-up period. The patients who completed the follow-up period in one stimulation group and those who informed consent were included in the other group. Results: Fifty percent of the patients (n = 6) were female and the mean age was 34,50 ± 8,78 years. The age of seizure onset was 4-26 years, and the duration of the disease was 15-36 years (23,83 ± 7,15). There was a statistically significant decrease in the number of seizures in patients who received active stimulation (p <0,05). There was no statistically significant difference between the total number of seizures before and after administration of placebo stimulation. In EEG, there was no significant difference in generalized discharge and focal focus numbers between the two groups before and after the application. In QOLIE 89 scale, the increase in scores after active stimulation was significant (p <0,01). There was no significant difference in SCL-90 score between before and after active stimulation (p> 0,05). Conclusion: In patients with refractory epilepsy, a positive effect of 30 Hz TBS on seizure frequency was observed.