Abstract
Epilepsia partialis continua (EPC) is a rare type of focal motor status epilepticus that causes continuous muscle jerking in a specific part of the body. Experiencing this type of seizure, along with other seizure types, such as focal motor seizures and focal to bilateral tonic-clonic seizures, can result in a disabling situation. Non-invasive brain stimulation methods like transcranial direct current stimulation (tDCS) show promise in reducing seizure frequency (SF) when medications are ineffective. However, research on tDCS for EPC and related seizures is limited. We evaluated personalized multichannel tDCS in drug-resistant EPC of diverse etiologies for long-term clinical efficacy We report three EPC patients undergoing a long-term protocol of multichannel tDCS. The patients received several cycles (11, 9, and 3) of five consecutive days of stimulation at 2 mA for 2 × 20 min, targeting the epileptogenic zone (EZ), including the central motor cortex with cathodal electrodes. The primary measurement was SF changes. In three cases, EPC was due to Rasmussen’s Encephalitis (case 1), focal cortical dysplasia (case 2), or remained unknown (case 3). tDCS cycles were administered over 6 to 22 months. The outcomes comprised a reduction of at least 75% in seizure frequency for two patients, and in one case, a complete cessation of severe motor seizures. However, tDCS had no substantial impact on the continuous myoclonus characterizing EPC. No serious side effects were reported. Long-term application of tDCS cycles is well tolerated and can lead to a considerable reduction in disabling seizures in patients with various forms of epilepsy with EPC.
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Abbreviations
- Tdcs:
-
Transcranial Direct Current Stimulation
- EPC:
-
Epilepsia Partialis Continua
- EZ:
-
Epileptogenic Zone
- SF:
-
Seizure Frequency
- EEG:
-
Electroencephalography
- rTMS:
-
Repetitive Transcranial Magnetic Stimulation
- FCD:
-
Focal Cortical Dysplasia
- ASM:
-
Antiseizure Medication
- SOZ:
-
Seizure Onset Zone
- SEEG:
-
Stereoelectrocencephalography
- MRI:
-
Magnetic Resonance Imaging
- EI:
-
Epileptogenic Index
- AEs:
-
Adverse Events
- TNF:
-
Tumor Necrosis Factor
- FDG-PET:
-
Fluorodeoxyglucose Positron Emission Tomography
- EMG:
-
Electromyography
- CSF:
-
Cerebrospinal Fluid
- LTP:
-
Long-term Potentiation
- LTD:
-
Long-term Depression
- NMDA Receptor:
-
N-methyl-D-aspartate receptor
- AMPA receptor:
-
α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor
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Acknowledgements
We thank Dr Luc Valton (CHU Toulouse) and Dr Claire Bar (CHU Bordeaux) for referring patients to our center.
Funding
This study is supported by the European Research Council: Galvani project, ERC-SyG 2019, grant agreement No 855109.
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Maeva Daoud: Methodology, Data analysis, Validation, Visualization, Writing – Original Draft Preparation, Review & Editing.Clémence Durelle: Methodology, Data analysis, Supervision, Validation, Writing – Original Draft Preparation, Review & Editing.Alexane Fierain: Data Curation and AnalysisNada El Youssef: Data Curation and analysisFabrice Wendling: Data analysis, Writing – Original Draft Preparation, Review & Editing.Giulio Ruffini: Methodology, Data analysis, Validation, Writing – Original Draft Preparation, Review & Editing.Pascal Benquet: Data analysis, Writing – Original Draft Preparation, Review & Editing.Fabrice Bartolomei: Conceptualization, Methodology, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Review & Editing.
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The non-invasive brain stimulation device used in this study was produced by Neuroelectrics Corp. and Starlab Neuroscience. Dr. Giulio Ruffini is a co-founder of these companies. All the other authors state there is no conflict of interest.
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Daoud, M., Durelle, C., Fierain, A. et al. Long-term Effect of Multichannel tDCS Protocol in Patients with Central Cortex Epilepsies Associated with Epilepsia Partialis Continua. Brain Topogr (2024). https://doi.org/10.1007/s10548-024-01045-3
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DOI: https://doi.org/10.1007/s10548-024-01045-3