Repetitive transcranial magnetic stimulation for the treatment of refractory epilepsy

Carrette, Sofie; Boon, Paul; Dekeyser, Cathérine; Klooster, Debby; Carrette, Evelien; Meurs, Alfred; Raedt, Robrecht; Baeken, Chris; Vanhove, Christian; Aldenkamp, Albert P.; Vonck, Kristl

doi:10.1080/14737175.2016.1197119

Cited by 22 publications

(15 citation statements)

References 90 publications

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“…A better understanding of the stimulation parameters which mediate input-specific synaptic changes, together with molecular studies on how rTMS modulates excitation/inhibition-balance, may help devising new therapeutic strategies using rTMS combined with pharmacological intervention. These studies could support for example, the development of more efficient rTMS-based therapies in post-stroke rehabilitation (Ziemann, 2005; Brodie et al, 2014; Smith and Stinear, 2016) or epilepsy (e.g., Carrette et al, 2016; Gersner et al, 2016), which already intend to target alterations in excitation/inhibition-balance. We hope rTMS-induced local disinhibition will be considered in future basic and clinical studies.…”

Section: Some Open Questions and Future Directionsmentioning

confidence: 98%

Releasing the Cortical Brake by Non-Invasive Electromagnetic Stimulation? rTMS Induces LTD of GABAergic Neurotransmission

Lenz

Vlachos

2016

Front. Neural Circuits

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Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive brain stimulation technique which modulates cortical excitability beyond the stimulation period. However, despite its clinical use rTMS-based therapies which prevent or reduce disabilities in a functionally significant and sustained manner are scarce. It remains unclear how rTMS-mediated changes in cortical excitability, which are not task- or input-specific, exert beneficial effects in some healthy subjects and patients. While experimental evidence exists that repetitive magnetic stimulation (rMS) is linked to the induction of long-term potentiation (LTP) of excitatory neurotransmission, less attention has been dedicated to rTMS-induced structural, functional and molecular adaptations at inhibitory synapses. In this review article we provide a concise overview on basic neuroscience research, which reveals an important role of local disinhibitory networks in promoting associative learning and memory. These studies suggest that a reduction in inhibitory neurotransmission facilitates the expression of associative plasticity in cortical networks under physiological conditions. Hence, it is interesting to speculate that rTMS may act by decreasing GABAergic neurotransmission onto cortical principal neurons. Indeed, evidence has been provided that rTMS is capable of modulating inhibitory networks. Consistent with this suggestion recent basic science work discloses that a 10 Hz rTMS protocol reduces GABAergic synaptic strength on principal neurons. These findings support a model in which rTMS-induced long-term depression (LTD) of GABAergic synaptic strength mediates changes in excitation/inhibition-balance of cortical networks, which may in turn facilitate (or restore) the ability of stimulated networks to express input- and task-specific associative synaptic plasticity.

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Section: Some Open Questions and Future Directionsmentioning

confidence: 98%

Releasing the Cortical Brake by Non-Invasive Electromagnetic Stimulation? rTMS Induces LTD of GABAergic Neurotransmission

Lenz

Vlachos

2016

Front. Neural Circuits

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“…Application of cTBS to M1 and other brain areas has been used to measure abnormalities in cortical plasticity and to assess therapeutic responses to interventions aimed at restoring normal cortical plasticity in several neurological and psychiatric disorders, including Alzheimer’s disease (Freitas et al, 2011a), autism spectrum disorders and fragile X syndrome (Oberman et al, 2010, 2012, 2014, 2016), dementia (Cantone et al, 2014), epilepsy (Carrette et al, 2016), essential tremor (Chuang et al, 2014), hemispatial neglect (Cazzoli et al, 2012; Koch et al, 2012), major depression (Li et al, 2014), multiple sclerosis (Mori et al, 2013), obsessive-compulsive disorders (Wu et al, 2010; Suppa et al, 2014), Parkinson’s disease (Koch et al, 2009), schizophrenia (Poulet et al, 2009; Eberle et al, 2010; McClintock et al, 2011), stroke (Ackerley et al, 2010; Hsu et al, 2012; Di Lazzaro et al, 2013, 2016), tinnitus (Forogh et al, 2014), and Tourette syndrome (Suppa et al, 2014). …”

Section: Introductionmentioning

confidence: 99%

Interindividual variability in response to continuous theta-burst stimulation in healthy adults

Jannati

Block

Oberman

et al. 2017

Clinical Neurophysiology

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Objective We used complete-linkage cluster analysis to identify healthy subpopulations with distinct responses to continuous theta-burst stimulation (cTBS). Methods 21 healthy adults (age±SD, 36.9±15.2 years) underwent cTBS of left motor cortex. Natural log-transformed motor evoked potentials (LnMEPs) at 5–50 minutes post-cTBS (T5–T50) were calculated. Results Two clusters were found; Group 1 (n=12) that showed significant MEP facilitation at T15, T20, and T50 (p’s<.006), and Group 2 (n=9) that showed significant suppression at T5–T15 (p’s<.022). LnMEPs at T10 and T40 were best predictors of, and together accounted for 80% of, cluster assignment. In an exploratory analysis, we examined the roles of brain-derived neurotrophic factor (BDNF) and apolipoprotein E (APOE) polymorphisms in the cTBS response. Val66Met participants showed greater facilitation at T10 than Val66Val participants (p=.025). BDNF and cTBS intensity predicted 59% of interindividual variability in LnMEP at T10. APOE did not significantly affect LnMEPs at any time point (p’s>.32). Conclusions Data-driven cluster analysis can identify healthy subpopulations with distinct cTBS responses. T10 and T40 LnMEPs were best predictors of cluster assignment. T10 LnMEP was influenced by BDNF polymorphism and cTBS intensity. Significance Healthy adults can be sorted into subpopulations with distinct cTBS responses that are influenced by genetics.

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“…In the study of Tergau and colleagues, actively treated patients experienced a significant approximately 40% reduction in seizure frequency compared with baseline, but this difference was not significant when compared with the placebo group. Reported adverse events include headache, dizziness, and tinnitus, but in none of the RCTs, these occurred at statistically significantly higher rates in the active treatment group [50][51][52]. In conclusion, although there is some evidence that rTMS is safe and well-tolerated;, there is insufficient evidence that proves its efficacy in reducing seizure frequency in patients with refractory epilepsy.…”

Section: Traditional and Novel Antiepileptic Devicesmentioning

confidence: 84%

Novel therapies for epilepsy in the pipeline

Mesraoua

Deleu

Kullmann

et al. 2019

Epilepsy & Behavior

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Despite the availability of many antiepileptic drugs (AEDs) (old and newly developed) and, as recently suggested, their optimization in the treatment of patients with uncontrolled seizures, more than 30% of patients with epilepsy continue to experience seizures and have drug-resistant epilepsy; the management of these patients represents a real challenge for epileptologists and researchers. Resective surgery with the best rates of seizure control is not an option for all of them; therefore, research and discovery of new methods of treating resistant epilepsy are of extreme importance. In this article, we will discuss some innovative approaches, such as P-glycoprotein (P-gp) inhibitors, gene therapy, stem cell therapy, traditional and novel antiepileptic devices, precision medicine, as well as therapeutic advances in epileptic encephalopathy in children; these treatment modalities open up new horizons for the treatment of patients with drug-resistant epilepsy.

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Repetitive transcranial magnetic stimulation for the treatment of refractory epilepsy

Cited by 22 publications

References 90 publications

Releasing the Cortical Brake by Non-Invasive Electromagnetic Stimulation? rTMS Induces LTD of GABAergic Neurotransmission

Releasing the Cortical Brake by Non-Invasive Electromagnetic Stimulation? rTMS Induces LTD of GABAergic Neurotransmission

Interindividual variability in response to continuous theta-burst stimulation in healthy adults

Novel therapies for epilepsy in the pipeline

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