rTMS for Epilepsy: What a Review Found About Short-Term Seizure Reduction

What was studied

Researchers systematically reviewed 14 randomized controlled trials involving 516 adults with epilepsy, including adults with drug-resistant focal epilepsy. Eight trials, with 367 participants, were combined in a meta-analysis.

The trials compared active low-frequency repetitive transcranial magnetic stimulation (rTMS), delivered at 0.3–1 Hz, with sham stimulation or an active control such as antiseizure medication. The review itself did not directly enroll participants.

What they found

Low-frequency rTMS was associated with a statistically significant short-term reduction in weekly seizure frequency compared with control treatment. Across the pooled studies, the mean number of seizures was 6.1 per week in the rTMS groups versus 7.4 per week in the control groups. Statistical heterogeneity was low, and the analysis did not detect significant publication bias.

Limits of the evidence

Eight of the 14 reviewed trials were included in the pooled analysis. Follow-up was limited, so it is uncertain whether the reduction in seizures lasts over the longer term. The evidence was from adults and does not establish whether the findings apply to children. The abstract does not report side effects, individual response rates, quality of life, or detailed differences among treatment protocols. Larger, standardized randomized trials with longer-term outcomes are needed.

For families and caregivers

The findings suggest that low-frequency rTMS may reduce seizure frequency over the short term in adults with epilepsy. The studied population included some adults with drug-resistant focal epilepsy, but the abstract does not report a separate result for that group. It remains uncertain whether benefits last, and the abstract does not provide enough information to draw conclusions about safety or replacing established epilepsy treatments.

What to watch next

Larger, standardized randomized controlled trials with longer follow-up are needed to determine whether reductions in seizure frequency are durable.

Terms in this summary

rTMS

A noninvasive treatment that uses repeated magnetic pulses applied through the scalp to influence brain activity.

low-frequency

Magnetic pulses delivered slowly; in these trials, at 0.3–1 pulse per second.

randomized controlled trial

A study in which participants are assigned by chance to a treatment group or a comparison group.

sham stimulation

A comparison procedure designed to resemble active stimulation without delivering the same intended stimulation.

meta-analysis

A statistical method that combines results from several studies.

drug-resistant focal epilepsy

Epilepsy in which seizures begin in one area of the brain and continue despite medication treatment.

standardized mean difference

A statistical measure used to compare the size of an effect across studies.

publication bias

A possible distortion that can occur when the likelihood of publication is related to a study's findings.