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

doi:10.1016/j.ebcr.2016.03.001

. 2016 Mar 16:5:52-6.

doi: 10.1016/j.ebcr.2016.03.001. eCollection 2016.

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

R Gersner¹, L Oberman², M J Sanchez³, N Chiriboga³, H L Kaye³, A Pascual-Leone⁴, M Libenson³, Y Roth⁵, A Zangen⁵, A Rotenberg¹

Affiliations

¹ Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
² Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States.
³ Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
⁴ Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
⁵ Department of Life Sciences, Ben-Gurion University, Beer-Sheva, Israel.

PMID: 27114902
PMCID: PMC4832041
DOI: 10.1016/j.ebcr.2016.03.001

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

R Gersner et al. Epilepsy Behav Case Rep. 2016.

. 2016 Mar 16:5:52-6.

doi: 10.1016/j.ebcr.2016.03.001. eCollection 2016.

Authors

R Gersner¹, L Oberman², M J Sanchez³, N Chiriboga³, H L Kaye³, A Pascual-Leone⁴, M Libenson³, Y Roth⁵, A Zangen⁵, A Rotenberg¹

Affiliations

¹ Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
² Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States.
³ Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
⁴ Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
⁵ Department of Life Sciences, Ben-Gurion University, Beer-Sheva, Israel.

PMID: 27114902
PMCID: PMC4832041
DOI: 10.1016/j.ebcr.2016.03.001

Abstract

Low frequency repetitive TMS (rTMS) of a cortical seizure focus is emerging as an antiepileptic treatment. While conventional rTMS stimulators activate only superficial cortical areas, reaching deep epileptic foci, for example in temporal lobe epilepsy (TLE), is possible using specially designed H-coils. We report the results of rTMS in a young adult with pharmacoresistant bilateral TLE who 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 of the procedure. Seizure frequency declined significantly, by 50 to 70% following each rTMS course. All sessions were well-tolerated.

Keywords: EEG, electroencephalogram; Epilepsy; FDA, Food and Drug Administration; MMSE, Mini-mental State Exam; MRI, magnetic resonance imaging; MT, motor threshold; Neuromodulation; TLE, temporal lobe epilepsy; TMS, transcranial magnetic stimulation; Transcranial magnetic stimulation; rMT, resting MT; rTMS, repetitive TMS.

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Figures

**Fig. 1**
Schematic of right hemisphere H12 coil in prime position. Note the relatively broad distribution of the stimulating elements over the right hemisphere.

**Fig. 2**
Daily seizure count before and after rTMS. Number of single seizures and seizure clusters (gray and black parts of stacked columns, accordingly) before and after first (A), second (B), and third (C) rTMS courses. Black arrow marks the treatment block with associated number of sessions.

**Fig. 3**
The effect of H-coil rTMS on seizure count. Data are presented as mean ± SEM of baseline (black) and follow-up (white) single seizures (A), seizures cluster (B), and total seizure count (C). Both single seizures (A) and total seizure count were reduced following all three treatment blocks. Seizure cluster (B) reduction displayed following first and third but not second treatment block. * p

See this image and copyright information in PMC

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References

1. Pereira L.S., Müller V.T., da Mota Gomez M., Rotenberg A., Fregni F. Safety of repetitive transcranial magnetic stimulation in patients with epilepsy: a systematic review. Epilepsy Behav. 2016;57(Pt A):167–176. [Epub ahead of print] - PubMed
1. Rossi S., Hallett M., Rossini P.M., Pascual-Leone A., Safety of TMS Consensus Group Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009;120:2008–2039. - PMC - PubMed
1. Chen R., Classen J., Gerloff C., Celnik P., Wassermann E.M., Hallett M. Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation. Neurology. 1997;48:1398–1403. - PubMed
1. Fregni F., Otachi P.T., Do Valle A., Boggio P.S., Thut G., Rigonatti S.P. A randomized clinical trial of repetitive transcranial magnetic stimulation in patients with refractory epilepsy. Ann Neurol. 2006;60:447–455. - PubMed
1. Sun W., Mao W., Meng X., Wang D., Qiao L., Tao W. Low-frequency repetitive transcranial magnetic stimulation for the treatment of refractory partial epilepsy: a controlled clinical study. Epilepsia. 2012;53:1782–1789. - PubMed

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[1] Pereira L.S., Müller V.T., da Mota Gomez M., Rotenberg A., Fregni F. Safety of repetitive transcranial magnetic stimulation in patients with epilepsy: a systematic review. Epilepsy Behav. 2016;57(Pt A):167–176. [Epub ahead of print] - PubMed

[2] Pereira L.S., Müller V.T., da Mota Gomez M., Rotenberg A., Fregni F. Safety of repetitive transcranial magnetic stimulation in patients with epilepsy: a systematic review. Epilepsy Behav. 2016;57(Pt A):167–176. [Epub ahead of print] - PubMed

[3] Rossi S., Hallett M., Rossini P.M., Pascual-Leone A., Safety of TMS Consensus Group Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009;120:2008–2039. - PMC - PubMed

[4] Rossi S., Hallett M., Rossini P.M., Pascual-Leone A., Safety of TMS Consensus Group Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009;120:2008–2039. - PMC - PubMed

[5] Chen R., Classen J., Gerloff C., Celnik P., Wassermann E.M., Hallett M. Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation. Neurology. 1997;48:1398–1403. - PubMed

[6] Chen R., Classen J., Gerloff C., Celnik P., Wassermann E.M., Hallett M. Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation. Neurology. 1997;48:1398–1403. - PubMed

[7] Fregni F., Otachi P.T., Do Valle A., Boggio P.S., Thut G., Rigonatti S.P. A randomized clinical trial of repetitive transcranial magnetic stimulation in patients with refractory epilepsy. Ann Neurol. 2006;60:447–455. - PubMed

[8] Fregni F., Otachi P.T., Do Valle A., Boggio P.S., Thut G., Rigonatti S.P. A randomized clinical trial of repetitive transcranial magnetic stimulation in patients with refractory epilepsy. Ann Neurol. 2006;60:447–455. - PubMed

[9] Sun W., Mao W., Meng X., Wang D., Qiao L., Tao W. Low-frequency repetitive transcranial magnetic stimulation for the treatment of refractory partial epilepsy: a controlled clinical study. Epilepsia. 2012;53:1782–1789. - PubMed

[10] Sun W., Mao W., Meng X., Wang D., Qiao L., Tao W. Low-frequency repetitive transcranial magnetic stimulation for the treatment of refractory partial epilepsy: a controlled clinical study. Epilepsia. 2012;53:1782–1789. - PubMed

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

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

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