Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation (TMS) is a non-invasive neurostimulation technique that generates a large magnetic field by inducing a current in a coil of copper wire. TMS can be delivered repetitively (rTMS) using either low-frequency (LF-rTMS, ≤1 Hz) or high frequency (HF-rTMS, ≥5 Hz) stimulation.

TMS and epilepsy

At present, rTMS is not yet approved for the treatment of epilepsy. Nevertheless, a growing number of clinical trials have been conducted to evaluate its efficacy. These studies have demonstrated a meaningful reduction in seizure frequency in approximately 50% of patients. A major ongoing challenge lies in identifying the optimal stimulation parameters for this specific condition. Through our research at 4BRAIN, we aim to address these limitations and contribute to the advancement of rTMS. Ultimately, this may support its development as a safe, effective, and non-invasive therapeutic option for individuals with epilepsy.

TMS and status epilepticus

Each year, we encounter a number of patients – both with and without a prior diagnosis of epilepsy – who develop status epilepticus. This condition is characterized by abnormally prolonged seizure activity and often needs admission to the intensive care unit, where patients may require treatment under general anesthesia. Despite advances in care, status epilepticus remains associated with a very high mortality rate, ranging from 30% to 50%.

In addition to exploring rTMS as a treatment for epilepsy, we are investigating its potential role in the acute setting. To date, only a limited number of status epilepticus cases worldwide have been treated with this technique, but the reported outcomes are promising. However, the application of rTMS in this population requires a deeper understanding of the underlying neurophysiological mechanisms in order to determine optimal stimulation targets and parameters. To address this, we are currently studying the functional connectivity of the brain in patients with status epilepticus. The goal of this research is not only to improve our understanding of the condition’s underlying mechanisms, but also to identify a stimulation target that may be broadly applicable across patients. If such a target can be established, it could pave the way for non-invasive treatment strategies, and importantly, contribute to reducing the high mortality associated with this condition.