Right Temporoparietal Junction Transcranial Magnetic Stimulation in the Treatment of Psychogenic Nonepileptic Seizures: A Case Series

Abstract

BACKGROUND: Psychogenic non-epileptic seizures (PNES) may involve hypoactivity in the right temporoparietal junction (TPJ), suggesting a promising target for therapeutic neuromodulation. In this proof-of-concept case series, we aimed to investigate the tolerability and potential efficacy of high frequency repetitive Transcranial Magnetic Stimulation (rTMS) over the right TPJ to decrease non-epileptic seizure rates.

METHODS: Seven subjects with video-EEG documented PNES without comorbid epileptic seizures were recruited. The rTMS protocol involved thirty stimulation sessions administered twice per day over three weeks. Each session consisted of three thousand pulses of high frequency (10 Hz) rTMS applied over the right TPJ. Tolerability was monitored throughout treatment. Weekly PNES counts were recorded at baseline, during treatment, and at post treatment intervals as the primary outcome measure. Additional psychometric scales assessing dissociation and functional neurological symptoms were collected at baseline and within 1-week post treatment as secondary outcome measures.

RESULTS: Treatment with rTMS was well tolerated by all participants. Participants reported a decrease in weekly seizure rates post vs. pre-treatment, which was sustained at 3-month follow-up. Improvement was also reported on the Dissociative Experiences Scale and the Conversion Disorder Subscale of the Screening for Somatoform Symptoms-7 Scale.

CONCLUSION: High-frequency rTMS over the right TPJ represents a promising treatment for PNES that warrants additional research.

Conflict of interest statement

Conflict of interest:

None

Figures

Figure 1. Seizure counts in patients with psychogenic nonepileptic seizures (PNES) receiving rTMS

Weekly seizure count logs kept by patients with PNES receiving rTMS treatment. Note: Subject 2 received two weeks of treatment. For this subject, post-treatment seizure recording begins at ‘Tx wk3’. Abbreviations: tx: treatment; wk: week; mth: month; f/u: follow-up.