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Reduction of cortical myoclonus-related epileptic activity following slow-frequency rTMS. A case study

In a drug-resistant epilepsy patient with continuous forearm/hand positive myoclonia due to a focal cortical dysplasia of the right motor cortex, cortical jerk-related and electromyographic activity were recorded for 15 min before and after 1 Hz rTMS (15 min, 10% below the resting excitability threshold) of the right motor cortex. A stable negative cortical spike, time-locked with contralateral muscle jerks (60 > 100 μV), was detected only at perirolandic electrodes (maximal amplitudes: block 1 = 21.3 μV, block 2 = 22 μV, block 3 = 25.9 μV). After rTMS, only 20 muscle jerks accomplished the criterion of >100 μV; blind back-averaging of these disclosed a topographically similar cortical spike, but with amplitude reduced by at least 50% (11.2 μV). This represents in vivo evidence of the possibility to selectively modulate the activity of an epileptic focus by intervening with local low-frequency rTMS.