Epileptic seizures triggered directly by focal transcranial magnetic stimulation

doi:10.1016/0013-4694(94)00249-K

Electroencephalography and Clinical Neurophysiology

Volume 94, Issue 1, January 1995, Pages 19-25

https://doi.org/10.1016/0013-4694(94)00249-K Get 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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Citation Excerpt :
This seizure occurred during 10 Hz motor cortex stimulation at 208% resting motor threshold (rMT), an unfavorable protocol that highlights improved safety guidelines since that era. In 1995, the first TMS-induced focal motor seizure was documented by electromyography [11]. Consensus safety guidelines for TMS were first published in 1998 [12], approximately three years after the first pilot study of repetitive TMS (rTMS) for depression [13].
Seizures are rare during repetitive transcranial magnetic stimulation (rTMS) treatment, but estimating risk is difficult because of study heterogeneity and sampling limitations. Moreover, there are few studies comparing rates between device manufacturers.
The objective of this study was to calculate rTMS seizure rates across various FDA-cleared devices in naturalistic clinical settings.
In July and August 2018, approximately 500 members of the Clinical TMS Society (CTMSS) were electronically surveyed about seizures in their practices. Seizures were distinguished from non-seizures by a remote semi-structured interview with a Board-certified neurologist and Co-Chair of the CTMSS Standards Committee. Exact Poisson calculations were used to estimate seizure rates and confidence intervals across the four most widely used manufacturers.
The survey was completed by 134 members, with 9 responses excluded because of data inconsistencies. In total, 18 seizures were reported in 586,656 sessions and 25,526 patients across all device manufacturers. The overall seizure rate was 0.31 (95% CI: 0.18, 0.48) per 10,000 sessions, and 0.71 (95% CI: 0.42, 1.11) per 1000 patients. The Brainsway H-coil seizure rate of 5.56 per 1000 patients (95% CI: 2.77,9.95) was significantly higher (p < 0.001) than the three most widely used figure- 8 coil devices’ combined seizure rate of 0.14 per 1000 patients (95% CI: 0.01, 0.51).
The absolute risk of a seizure with rTMS is low, but generic Brainsway H-coil treatment appears to be associated with a higher relative risk than generic figure- 8 coil treatment. Well-designed prospective studies are warranted to further investigate this risk.
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Acupuncture, taking the advantage of modality-specific neural pathways, has shown promising results in the treatment of brain disorders that affect different modalities such as pain and vision. However, the precise underlying mechanisms of within-modality neuromodulation of acupoints on human high-order cognition remain largely unknown. In the present study, we used a non-invasive and easy-operating method, focused ultrasound, to stimulate two language-relevant acupoints, namely GB39 (Xuanzhong) and SJ8 (Sanyangluo), of thirty healthy adults. The effect of focused ultrasound stimulation (FUS) on brain activation was examined by functional magnetic resonance imaging (fMRI). We found that stimulating GB39 and SJ8 by FUS evoked overlapping but distinct brain activation patterns. Our findings provide a major step toward within-modality (in this case, language) acupoint-brain (acubrain) mapping and shed light on to the potential use of FUS as a personalized treatment option for brain disorders that affect high-level cognitive functions.
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Citation Excerpt :
Firstly, the PET and fMRI studies only showed correlational results and did not establish the causal relationship between a particular brain area and a certain aspect of behavioral and cognitive performance (He et al., 2016). Furthermore, Although the TMS studies could explore causality, it has been associated with the potential for causing seizures if inappropriately applied (Classen et al., 1995). Third, Although the lesion studies could also theoretically explore causality, it is difficult to find a sufficient number of participants with single interested brain lesion in the study, and these participants often have other complications (Koch, Oliveri, Carlesimo, & Caltagirone, 2002).
It is unclear whether altering the activity of the right dorsolateral prefrontal cortex (right DLPFC) affects an individual’s timing performance in milliseconds- and seconds range timing. Here we investigated the causal role of right DLPFC in milliseconds- and seconds range timing with a temporal bisection task under the application of transcranial direct current stimulation (tDCS) that altered the neural activities of the right DLPFC. The tDCS conditions consisted of anodal, cathodal, and sham conditions. The electrodes were placed over the F4 position (10–20 system) and on the left supraorbital forehead. In current study, participants completed two blocks of trials involving short (“Short blocks”: 200–800 ms) or longer (“Long blocks”: 1400–2600 ms) durations. The results showed that no significant differences in the bisection point (BP) were found among anodal condition, sham condition and cathodal condition in “Short blocks”. However, in “Long blocks”, the BP were found to be shifted toward the left for the anodal condition, sham condition, compared to cathodal condition, suggesting that the stimulus duration was judged to last longer for anodal condition compared to sham condition, whereas shorter for cathodal condition compared to sham condition. The results demonstrated that the right DLPFC played a causal role in seconds range timing (average duration 2000 ms), but not in milliseconds range timing (average duration 500 ms), which is shown it might be involved in the cognitive processing (for example, working memory process) based on dual-timing system and scalar timing theory.
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To evaluate the effect of diurnal variability on cortical excitability using single pulse transcranial magnetic stimulation (TMS), in drug naive patients with juvenile myoclonic epilepsy (JME) and to look for any differences in cortical excitability between males and females.
Thirty drug-naive patients with JME and 10 healthy controls were studied. Resting motor threshold (RMT), motor evoked potential (MEP), the duration of central motor conduction time (CMCT) and cortical silent period (CSP) were measured, twice, first early in the morning and again in the afternoon of the same day.
Diurnal variation with higher evening values of CMCT and CSP were observed in the control group. In the study group, diurnal variation in RMT, CMCT and CSP was found with higher values in the morning than in control group. However, only the raised values of CSP [mean, 110.7 ms, morning and 96.44 ms, evening] were of statistical significance [p = 0.005, morning and 0.039, evening] as compared to controls. In the study group, males had higher values of RMT, CMCT and CSP than in females. However, the CMCT in males was lower in the evening study than in females. Further, RMT and morning CMCT was lower in females than in controls. In females, the morning CSP [mean, 100.91 ms, morning versus 87.86 ms, evening] was significantly prolonged [p = 0.017, morning versus 0.221, evening] as compared to controls.
The study is suggestive of the existence of impaired supraspinal/intracortical inhibitory circuits which may account for the hyperexcitability of the motor system being prominent in the morning among drug naïve patients with JME. In this study, increased activity of cortical inhibitory networks, as evidenced by prolonged cortical silent period existed among drug naïve JME patients, but was found to be significant only in female patients. This may explain the increased seizure susceptibility in this cohort, at this time of the day and an increased manifestation of JME in females.

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Main articleEpileptic seizures triggered directly by focal transcranial magnetic stimulation

Abstract

Lancet

Lancet

Electroenceph. clin. Neurophysiol.

Matching focal and non-focal magnetic coil stimulation to properties of the human nervous system: mapping motor unit fields in motor cortex contrasted with altering sequential digit movements by premotor SMA stimulation

Magnetic stimulation of the human brain and peripheral nervous system: an introduction and the results of an initial clinical evaluation

Neurosurgery

Transcranial magnetic stimulation in patients with epilepsy

Neurology

Topographic organization of corticospinal projections from the frontal lobe: motor areas on the lateral surface of the hemisphere

J. Neurosci.

Induction of seizures by transcranial magnetic stimulation in epileptic patients

J. Neurol.

Main article
Epileptic seizures triggered directly by focal transcranial magnetic stimulation