Case Report: Prolonged Effects of Short-Term Transcranial Magnetic Stimulation on EEG Biomarkers, Spectral Power, and Seizure Frequency.
Case Report: Prolonged Effects of Short-Term Transcranial Magnetic Stimulation on EEG Biomarkers, Spectral Power, and Seizure Frequency.
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DOI：
10.3389/fnins.2022.866212
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发表时间：
2022
影响因子：
4.3
通讯作者：
Lundstrom, Brian Nils
中科院分区：
文献类型：
--
作者：
Starnes, Keith;Britton, Jeffrey W.;Burkholder, David B.;Suchita, Iffat A.;Gregg, Nicholas M.;Klassen, Bryan T.;Lundstrom, Brian Nils
经颅磁刺激（TMS）是一种非侵入性的局灶性脑刺激方式，其中波动的磁场在皮层内感应电流。目前尚不清楚TMS在多大程度上改变了EEG生物标志物以及EEG生物标志物如何指导局灶性癫痫的治疗。我们报告一例48岁男性局灶性癫痫，多种药物治疗无效，在使用低频重复经颅磁刺激（rTMS）靶向左顶枕区癫痫发作区域后，癫痫发作显著减少。在治疗前，他经历了影响认知的局灶性癫痫发作，包括失用症，每天至少50-60次。脑部MRI显示左侧枕-顶叶交界处存在大面积局灶性皮质发育不良伴对比增强。连续5天的刺激耐受性良好，并且与癫痫发作频率的逐日减少相关。此外，还对他进行了连续视频EEG监测，结果显示频谱功率持续和进行性变化（宽带功率降低，次声δ活动增加），癫痫发作频率和持续时间逐渐减少。初步治疗后1个月，2天动态脑电图显示无脑梗塞，MRI显示局灶性对比增强消退。他继续每2-4个月接受2-3天的rTMS。他在6个月内没有癫痫发作，在最后17个月的随访中，大约每2周出现一次先兆，没有进展为致残性癫痫发作。该病例表明，rTMS可以是控制药物难治性癫痫发作的耐受性良好且有效的手段，并且EEG生物标志物以与癫痫发作频率相关的方式逐渐变化。经颅磁刺激影响皮层兴奋性，是治疗局灶性癫痫的一种有前途的非侵入性手段，并具有可测量的电生理效应。
Transcranial magnetic stimulation (TMS) is a non-invasive modality of focal brain stimulation in which a fluctuating magnetic field induces electrical currents within the cortex. It remains unclear to what extent TMS alters EEG biomarkers and how EEG biomarkers may guide treatment of focal epilepsy. We present a case of a 48-year-old man with focal epilepsy, refractory to multiple medication trials, who experienced a dramatic reduction in seizures after targeting the area of seizure onset within the left parietal-occipital region with low-frequency repetitive TMS (rTMS). Prior to treatment, he experienced focal seizures that impacted cognition including apraxia at least 50–60 times daily. MRI of the brain showed a large focal cortical dysplasia with contrast enhancement involving the left occipital-parietal junction. Stimulation for 5 consecutive days was well-tolerated and associated with a day-by-day reduction in seizure frequency. In addition, he was monitored with continuous video EEG, which showed continued and progressive changes in spectral power (decreased broadband power and increased infraslow delta activity) and a gradual reduction in seizure frequency and duration. One month after initial treatment, 2-day ambulatory EEG demonstrated seizure-freedom and MRI showed resolution of focal contrast enhancement. He continues to receive 2–3 days of rTMS every 2–4 months. He was seizure-free for 6 months, and at last follow-up of 17 months was experiencing auras approximately every 2 weeks without progression to disabling seizures. This case demonstrates that rTMS can be a well-tolerated and effective means of controlling medication-refractory seizures, and that EEG biomarkers change gradually in a fashion in association with seizure frequency. TMS influences cortical excitability, is a promising non-invasive means of treating focal epilepsy, and has measurable electrophysiologic effects.
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