Possibly lifesaving, noninvasive, EEG-guided neuromodulation in anesthesia-refractory partial status epilepticus

This study aimed to investigate the effect of low frequency repetitive transcranial magnetic stimulation (rTMS) guided as to localization and effect by continuous EEG on a super-refractory status epilepticus unresponsive to conventional treatment for 44 days including repeated deep sedation. Repetitive transcranial magnetic stimulation was delivered for one-hour sessions to the most active of two EEG foci for 8 days. From the third day of stimulation, the EEG pathology markedly decreased in parallel to clinical improvement. The patient could be weaned off the respirator, transferred to an ordinary ward then to a rehabilitation clinic. This is the first report of a positive outcome of rTMS treatment in super-refractory status epilepticus. In the context of refractory partial status epilepticus, neuromodulation through rTMS is a safe treatment option. If performed along the lines herein described, it may also be more efficient than conventional treatment. Repetitive transcranial magnetic stimulation may be an underused treatment option for status epilepticus. (C) 2012 Elsevier Inc. All rights reserved.