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Epileptic seizures triggered directly by focal transcranial magnetic stimulation

https://doi.org/10.1016/0013-4694(94)00249-KGet rights and content

Abstract

Focal, secondarily generalizing epileptic seizures were released by magnetic stimulation in a patient with focal epilepsy. The stimulation induced seizures had a similar clinical appearance to the patient's spontaneous seizures. They were released exclusively by an angulated “figure-of-8” coil which stimulates the brain more focally as compared to the commonly used flat round coil. The epileptic focus could be located in the left frontal cortex by electroencephalographic recordings, by magnetic resonance and by positron emission tomography imaging. Functional assessment of the motor system by transcranial magnetic stimulation (TMS) disclosed markedly prolonged electrical silence of contralesional electromyographic activity following the early excitation. This is the first EMG-documented demonstration of a focal motor seizure directly triggered by magnetic brain stimulation.

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    Recent guidelines estimate a risk lower than < 0.03% of seizure induction during TMS (Wassermann, 1998; Schrader et al., 2004; Lerner et al., 2019; Chou et al., 2020); however, there are no systematic data on the effects of sp/ppTMS at the electrophysiological and clinical level. Most previous reports of seizure incidence in sp/ppTMS were anecdotal, presenting single events with inconclusive results and research parameters that may not meet current TMS research guidelines (Hömberg and Netz, 1989; Fauth et al., 1992; Classen et al., 1995; Michelucci et al., 1996; Haupts et al., 2004; Tharayil et al., 2005). Additionally, study design heterogeneity, small sample sizes and diversity of clinical profiles are all potential confounding factors that may influence risk estimation (Tremblay et al., 2019).

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