Transcranial magnetic stimulation for refractory focal status epilepticus in the intensive care unit

Abstract

Purpose To examine the efficacy and safety profile of antiepileptic repetitive transcranial magnetic stimulation (rTMS) for refractory status epilepticus (RSE) in the intensive care unit (ICU) setting. In addition, hypothetical concerns about electrical interference of rTMS with ICU equipment have been previously raised. Methods We describe two cases of RSE treated with rTMS in the ICU. Results In one case, rTMS contributed to decreased seizure frequency; in the second case, rTMS transiently decreased seizure frequency. In both cases, rTMS was safe and did not interfere with the functioning of the ICU equipment. Conclusion rTMS is a potential therapy for RSE when conventional therapies have failed. Future studies should investigate the efficacy of various rTMS stimulation parameters, safety issues, and bioengineering considerations in the ICU setting.

Treatment of Super-Refractory Status Epilepticus

“…Liu et al has reported the use of low frequency rTMS in two ICU patients with refractory focal SE. Both patients showed at least 50 % reduction in seizures frequency after rTMS application [56]. Although no therapeutic conclusion can be obtained from such a small sample, there is an important point here, which is rTMS does not interfere with the ICU equipment and can be safely used in the ICU setting.…”

“…Repetitive TMS is able to stimulate the brain in a way similar to ECT; however, it is more focal and localized compared to ECT. Although most of rTMS use is in the inter-ictal state (i.e., not in actively seizing patients), there are few reports about the use of rTMS in acute focal SE treatment [56]. Liu et al has reported the use of low frequency rTMS in two ICU patients with refractory focal SE.…”

A facilitation tool: transcranial magnetic stimulation in epilepsy research

“…Besides the controlled studies, many open label studies have made attempts in treating epilepsy with rTMS. Most of these studies were conducted during the interictal state as the controlled studies were, yet rTMS can also be applied during the ictal state and preliminary studies showed its efficacy in suppress seizures (38). Although there are still many questions remained and the underlying mechanisms are not fully uncovered, rTMS is still considered as a novel, prospective and relatively safe therapeutic method.…”

Treatment of refractory generalized status epilepticus in a patient with unresponsive wakefulness syndrome: Is neuromodulation the future?

“…N 20 component of somatosensory-evoked potentials was bilaterally absent. In the last two months, the patient started to present recurrent seizures, i.e., 3-8 daily, characterized by myoclonic jerks mainly involving face and trunk, lasting a few minutes (usually [3][4][5]. The EEG showed bilateral spike/polyspike and sharp-wave activity (although prominent in the frontal lobes), and a focal origin was never observed.…”