Transcranial Magnetic Stimulation for Status Epilepticus

Table 2

rTMS treatment characteristics, seizure response, and outcome.

Reference	Number of patients treated with rTMS	rTMS coil type	rTMS treatment regimen (trains/freq./ train duration)	Other AEDs on board	Electrographic seizure response	Duration of response	Adverse effects to rTMS	Patient outcome
Graff-Guerrero et al. [12]	2	Figure of 8	15/20 Hz/2 s train with intertrain of 58 s	1→ Valproic acid; Phenytoin; Primidone; Topiramate; 2→ Phenytoin; Clobazam; Valproic acid; Oxcarbazepine	1→ seizure cessation after 24 h; 2→ slight frequency decrease in epileptic spikes	1→ 2 weeks; 2→ N/A	None	1→ required hemispherectomy: biopsy showed Rasmussen’s encephalitis; 2→ minimal improvement
Hyllienmark and Åmark [13]	1	N/A	N/A	Lidocaine; Midazolam; Thiopental	Burst suppression	N/A	N/A	Good, seizures ceased
Liu et al. [14]	2	Figure of 8	1→ 1/1 Hz/1200 s; 2→ 1/1 Hz/1800 s	1→ Phenobarbital; Pregabalin; Lamotrigine; Fosphenytoin; Lacosamide; Levetiracetam; Pentobarbital; 2→ Lamotrigine; Levetiracetam; Felbatol; Lorazepam; Lacosamide	1→ seizure frequency and spike detections decreased; 2→ seizure frequency decreased	1→ until discharge (4 weeks); 2→ 72 hours	None	1→ discharged and sent to rehab on day 47; 2→ required further vagus nerve stimulation; returned to baseline and discharged on 11 days after TMS
Misawa et al. [15]	1	Figure of 8	100 pulses at 0.5 Hz	Clonazepam; Phenytoin	FSE suppression in hand but FSE in foot persisted	3 months	None	Patient underwent second TMS treatment which resulted in FSE suppression for 2 months
Morales et al. [16]	2	1→ round coil (5 cm diameter); 2→ figure of 8	1→ 2 sessions: 4/1 Hz/600 s and 10/6 Hz/5 s trains with 25-second intertrain interval followed by 1/1 Hz/600 s; 2→ 2 sessions: 1/1 Hz/900 s and 10/6 Hz/5 s with 25 s intertrain interval followed by 1/1 Hz/900 s	1→ Zonisamide; Phenobarbital; Coenzyme Q; Levetiracetam; Carnitine; 2→ Lamotrigine; Clobazam	1→ no response; 2→ no response	N/A	1 none; 2 increased leg pain and mild headache. Both resolved	1→ brain biopsy showed neuronal ceroid lipofuscinosis Patient died 3 months later; 2→ patient opted for surgery but no cortical resection could be done
Naro et al. [17]	1	Round	4 trains with 300 pulses/1 Hz; with 30-second intertrain interval	Levetiracetam; Valproate; Lorazepam	Complete remission	6 days	None	Myoclonic jerks reappeared though less frequent and intense
Rotenberg et al. [18]	7	Figure of 8	1→ 3/1 Hz/1800 s; 2→ 1/1 Hz/1600 s and 40/20 Hz/2 s followed by 1/1 Hz/1600 s; 3→ 40/20 Hz/1660 s; 4→ 2/1 Hz/1600 s; 5→ 1/1 Hz/200 s; 6→ 15/100 Hz/0.05–1.25 s & 10/1 Hz/1600–1800 s; 7→ 1/1 Hz/1800 s; 20/20 Hz/4 s	N/A	No effect = 2; Seizure ceased during TMS = 3; Seizure cessation after TMS = 2	Seizures ceased during TMS lasting 30 minutes; 1 patient = 2 days; 1 patient = >4 months	None	2/7 had no EEG response to TMS; 3/7 had a short-lived response lasting 20-30 min after TMS train before relapse of clinical seizures; 2/7 had lasting anticonvulsive effect throughout follow-up (2 days for 1 patient and >4 months for another)
Thordstein and Constantinescu [19]	1	Figure of 8	1/0.5 Hz/3600 s; 2 days of 1/day and; 6 days of 2/day	Fosphenytoin; Levetiracetam; Topiramate	Continuous seizures stopped, localized epileptiform activity recorded	2.5 months	None	Patient clinically improved slowly and has no epileptiform potentials 2.5 months later
Thordstein et al. [20]	2	N/A	1/0.5 Hz/3600 s daily for 2 weeks	N/A	Seizure severity decreased	N/A	None	Seizure frequency and severity both decreased
Van Haerents et al. [21]	1	N/A	3/1 Hz/600 s; 11 sessions	Zonisamide; Lamotrigine; Phenobarbital; Phenytoin	Seizure frequency progressively declined and then ceased	N/A	None	Complete seizure control and stabilization of epilepsy allowed patient to return to normal life
Wusthoff et al. [22]	1	N/A	N/A	N/A	No effect	N/A	N/A	Patient responded to ketogenic diet
Rotenberg et al. [23]	1	Figure of 8	1/1 Hz/1800 s (9 consecutive days)	Fosphenytoin; Oxcarbazepine; Levetiracetam; Valproate; Diazepam; Lorazepam	Seizure suppression during treatment	Effect only during treatment	None	Patient returned to baseline seizures

rTMS: repetitive transcranial magnetic stimulation; AED: anti-epileptic drug; TMS: transcranial magnetic stimulation; AED: antiepileptic drug; N/A: not available; SE: status epilepticus; FSE: focal status epilepticus; FRSE: focal refractory status epilepticus; GRSE: generalized refractory status epilepticus; yrs: years; mons: months; h: hours; s: seconds. Rotenberg et al. [18] contains a series of patients including the case description from Rotenberg et al. [23]. Thus, the data from Rotenberg et al. [23] was not included in the final summary and analysis of data in order to avoid duplication of patient data.