Repeated TMS at Low Frequencies to Reduce Seizure Occurrence
Repeated TMS at Low Frequencies to Reduce Seizure Occurrence
Perform non-invasive neuro-navigated repeated Transcranial Magnetic Stimulation (rTMS) at low
 frequencies (LF) with the intent to reduce the occurrence of seizures over time. Seizure
 reduction and improvements in the quality of life in patients with epilepsy will be
 associated with increased cortical inhibition resulting from the LF-rTMS sessions over time.
 This procedure using rTMS at low frequencies (LF-rTMS) between 0.5 and 1 Hz is a safe and
 painless method for noninvasive focal cortical brain stimulation, which will be evaluated in
 its efficacy at reducing/suppressing seizures. Accordingly, we propose a clinical trial in
 patients with epilepsy to test whether LF-rTMS can improve seizure suppression. The location
 of the presumed 3D source in the brain will be stimulated for few minutes (10 to 15 min.).
 With the same rTMS modality, we will also perform motor threshold mapping in conjunction with
 its fully integrated and compatible electroencephalography (EEG) module. Up to 100
 individuals 18 to 80 years with epilepsy will be enrolled.
Perform non-invasive neuro-navigated repeated Transcranial Magnetic Stimulation (rTMS) at low
 frequencies (LF) with to reduce the occurrence of seizures over time. Seizure reduction and
 improvements in the quality of life in patients with epilepsy will be associated with
 increased cortical inhibition resulting from the LF-rTMS sessions over time. This procedure
 using rTMS at low frequencies (LF-rTMS) between 0.5 and 1 Hz is a safe and painless method
 for noninvasive focal cortical brain stimulation, which will be evaluated in its efficacy at
 reducing/suppressing seizures. Accordingly, we propose a clinical trial in patients with
 epilepsy to test whether LF-rTMS can improve seizure suppression. The location of the
 presumed 3D source in the brain will be stimulated for few minutes (10 to 15 min.). Using a
 double-blinded, sham-controlled design, we will enroll up to 100 participants aged 18-80 with
 focal and generalized retractable epilepsy. Baseline data will include a detailed seizure
 diary over 4 weeks, psychometric testing/neuropsychology evaluation, and 20-minute EEG
 recordings. Each patient will then begin treatment with 14 minute sessions of 1 Hz rTMS or
 sham rTMS, 120%MT, and 800 stimuli on the position of the calculated 3D source using EEG,
 MRI, and digitized electrode locations. The protocol will be divided in 3 groups (Groups 1, 2
 and 3) as follows:

 -  Groups 1, 2, and 3: LF-rTMS for 2 weeks (5 days per week for total of 10 days).

 -  Group 1: protocol total duration: 1 year: LF-rTMS 1 session/week for 1 month (4 days),
 and LF-rTMS 1 session/month for 11 months

 -  Group 2: protocol total duration: 1 year: LF-rTMS 1session/month for 12 months

 -  Group 3 (placebo protocol, total duration: 1 year): LF-rTMS 1session/week for 1 month (4
 days); and LF-rTMS 1session/month.

 During each session EEG may be recorded. Also, we will obtain the number, frequency, and
 duration of seizure events from an ongoing seizure diary. Psychometric testing will be
 performed at the beginning of study, 3 months, and at the end of the study. Thus, each
 patient will have rTMS testing, psychometrics, and EEG recordings. With the same rTMS
 modality, we will also perform motor threshold mapping in conjunction with its fully
 integrated and compatible electroencephalography (EEG) module.
Inclusion Criteria:

 -  Experience ≥ 3 seizures/month in the month prior to starting study (any type of
 seizure will count)

 -  No status epilepticus in the last 12 months

 -  No change in medication in last 30 days

 Exclusion Criteria:

 -  Presence of implanted electronic devices (e.g., pacemaker, medication pump, brain or
 vagus nerve stimulator, cochlear implant)

 -  Presence of intracranial metal (e.g., aneurysm clip)

 -  Unable to cooperate with non-sedated, navigated TMS testing