Treating Deep Seizure Foci With Noninvasive Surface Brain Stimulation
Treating Deep Seizure Foci With Noninvasive Surface Brain Stimulation
The overall goal of this study is to open up the promising treatment of repetitive
 transcranial magnetic stimulation (rTMS), which has been shown to be effective against
 seizures in patients with surface neocortical foci, to a much larger population of patients
 with mesial temporal lobe epilepsy (MTLE) and other forms of epilepsy with deep foci, who are
 not currently considered good rTMS candidates.

 The investigators hypothesize that rTMS can modulate the hyperexcitable state in patients
 with deep seizure foci by targeting its usage to accessible cortical partner regions. In this
 study the investigators aim 1) to map the functional connectivity of the epileptogenic mesial
 temporal lobe in patients with medically refractory mesial temporal lobe epilepsy; and 2) to
 perform a randomized controlled assessment of repetitive transcranial magnetic stimulation
 protocols applied to specific neocortical targets in mesial temporal lobe epilepsy. The
 methods used in this study will include magnetic resonance imaging (MRI) of the brain,
 electroencephalography (EEG), and transcranial magnetic stimulation (TMS).
Inclusion Criteria:

 -  Diagnosis of mesial temporal lobe epilepsy based on the combination of clinical
 semiology, neuroimaging findings, and electroencephalogram results.

 -  At least 1 seizure with loss of awareness per 4-week period, on average, despite the
 use of antiepileptic drugs

 Exclusion Criteria:

 -  Prior brain surgery or exposure to transcranial magnetic stimulation

 -  Rapidly progressive brain lesions

 -  Inability to tolerate MRI or TMS

 -  Specific MRI or TMS contraindication as set forth in standard protocols of our
 institution