Trans-cranial Magnetic Stimulation in the treatment of non-epileptic seizures: A Case Series

Abstract

Psychogenic non-epileptic seizures (PNES) is a neurobehavioral condition that is poorly understood. Patients with PNES often exhibit an increase in comorbid mood, and anxiety disorders, and share phenotypic traits of emotion dysregulation, dissociation, and psychological trauma (3). Recent neuroimaging studies have implicated abnormalities in such areas as the right temporoparietal junction (TPJ) in patients with PNES. This region of the brain contributes to both awareness of motor intention, and self-agency. Impaired function in this area may thus play an important role in the pathophysiological mechanisms underlying PNES. Such impairments may prevent individuals from taking authorship of their movements, therefore perceiving them as involuntary. Currently there is no effective treatment for PNES. This study aims to 1) explore the prevalence of psychiatric disorders in patients with PNES and 2) investigate the efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) in decreasing the frequency of PNES episodes. A sample of 20 patients with PNES (confirmed by video EEG monitoring) will be recruited and assessed for psychiatric comorbidity, and functional impairment. Data will be collected using Research Electronic Data Capture (REDCap). Five of these patients will subsequently undergo 30 sessions of high frequency (10 Hz) rTMS applied over the right TPJ. The symptoms and functional impairment of patients receiving treatment will then be reassessed. Linear regression analysis will be used to evaluate functional disability against scores on REDCap scales for all patients. The relationship between concurrent psychiatric conditions, PNES symptoms, and their impact on patient function will be examined.