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  • Possible transcallosal seizure induction by paired pulse transcranial magnetic stimulation in a patient with frontal lobe epilepsy

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Letter
Possible transcallosal seizure induction by paired pulse transcranial magnetic stimulation in a patient with frontal lobe epilepsy
  1. J Reis,
  2. F Rosenow,
  3. B Fritsch,
  4. S Knake,
  5. W H Oertel,
  6. H M Hamer
  1. Interdisciplinary Epilepsy-Center, Department of Neurology, Philipps-University Marburg, Germany
  1. Correspondence to:
 J Reis
 Interdisciplinary Epilepsy-Center, Department of Neurology, Philipps-University Marburg, Rudolf-Bultmann-Str. 8, 35033 Marburg, Germany; reisstaff.uni-marburg.de

https://doi.org/10.1136/jnnp.2004.042127

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    Seizure induction by high frequency transcranial magnetic stimulation (TMS) has been reported in normal subjects and by single pulse TMS close to the epileptic focus in patients with epilepsy.1

    Case report

    We report an 18 year old patient with right frontal lobe epilepsy due to paramedian focal cortical dysplasia (FCD). The patient’s usual seizure semiology consisted of a somatosensory aura of the left hand followed by a tonic seizure of the left arm which evolved to a bilateral asymmetrical tonic seizure without loss of consciousness. In the two years preceding the study (see below) he had rare night-time seizures only. His antiepileptic medication consisted of levetiracetam 500 mg, phenobarbital 25 mg, and carbamazepine 1600 mg daily.

    During presurgical videoelectroencephalogram (video-EEG) monitoring, interictal EEG showed right frontotemporal spikes. Ictal EEG revealed seizure patterns with a right frontal onset. Magnetic resonance imaging (MRI) showed FCD in the right superior frontal gyrus extending into the right precentral gyrus (fig 1A). Neurological examination was normal.

    Figure 1

     (A) Axial T2-weighted magnetic resonance imaging (MRI) scan (fluid attenuated inversion recovery (FLAIR)) of the patient’s brain. T2 prolongation and blurring of grey-white junction represents focal cortical dysplasia of 1×1 cm (see circle) located in the right superior frontal sulcus (extending to the right motor cortex, seen in further MRI slices). (B) Examples of motor evoked potentials (MEPs) from the right abductor digiti minimi muscle (ADM) during transcranial magnetic stimulation …

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    Footnotes

    • Competing interests: none declared