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

R Gersner; L Oberman; M J Sanchez; N Chiriboga; H L Kaye; A Pascual-Leone; M Libenson; Y Roth; A Zangen; A Rotenberg

doi:10.1016/j.ebcr.2016.03.001

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

Epilepsy Behav Case Rep. 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.

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.