Abstract: Objective To observe the effectiveness of low-frequency and subthreshold repetitive transcranial magnetic stimulation (rTMS) on patients with refractory epilepsy. Methods Twelve subjects with refractory and focal epilepsy were involved. rTMS as a treatment with 600 pulses, intensity of 90% motor resting threshold and 0.50 Hz frequency was administrated once per day, 5 days as one course. Five of twelve patients accepted the second course treatment. The number of seizure frequency, seizure days, and seizure latency at pre- and pro-treatment were measured and compared. Meanwhile, the data of electroencephalography (EEG) was collected for calculation. Compared epileptic spike discharges in the EEG and relative power of each frequency distribution (%) by using the software running on MATLAB 7.0. Results rTMS significantly decreased the frequency and days of seizures after 5 days of the first treatment in all 12 patients (t = 2.450, P = 0.032; t = 2.797, P = 0.017), and prolonged seizure latency in 8 patients. Furthermore, high-frequency β band relative power distribution showed significant increase (t = -2.703, P = 0.021), especially in α band (t = -3.680, P = 0.004); while low-frequency δ band decreased (t = 3.047, P = 0.011). The amount of EEG sharp waves was reduced significantly (t = 2.411, P = 0.035). Compared with the first course, these indexes were improved in the second treatment. The changes of δ and α bands were great, especially δ band decreased by 2.08 times which suggested that EEG background waves were improved evidently. Conclusion Low-frequency and subthreshold rTMS can decrease the events of epileptic seizures, prolong seizure latency, and improve epileptic EEG discharges. As a new method in the area of non-drug-induced neuro-modulation, low-frequency rTMS is a safe and effective treatment for refractory epilepsy. It shows good prospects for clinical application of low-frequency rTMS in refractory epilepsy.

Key words: Epilepsies, partial, Transcranial magnetic stimulation, Electroencephalography

摘要： 目的   观察低频及阈下强度的重复经颅磁刺激治疗难治性癫痫的疗效。方法   采用重复经颅磁刺激治疗12 例难治性局灶性癫痫患者，分析并评价治疗前后癫痫发作频率、发作日及发作潜伏期；采集治疗前后脑电信号，分析脑电图各频带相对功率值（%）和尖波发放数目。结果   12 例患者经低频重复经颅磁刺激首次治疗后，癫痫发作频率及发作日均减少（t = 2.450，P = 0.032；t = 2.797，P = 0.017），其中8 例发作潜伏期延长。脑电图δ频带相对功率值（δ%）降低（t = 3.047，P = 0.011）、β频带相对功率值（β%）增加（t = -2.703，P = 0.021），尤以α频带相对功率值（α%）增加显著（t = -3.680，P = 0.004）；脑电图尖波发放数目减少（t = 2.411，P = 0.035）。再次治疗后上述指标仍呈改善趋势，δ%降低、α%增幅变大，尤其δ%降低幅度增加至2.08 倍，背景波明显改善。结论   采用低频、阈下强度的重复经颅磁刺激治疗难治性癫痫患者，可以减少临床发作频率、延长发作潜伏期和改善脑电图异常放电。低频重复经颅磁刺激作为非药物性神经调控领域的新方法，治疗难治性癫痫安全、有效，具有较好的临床应用前景。

关键词: 癫痫, 部分性, 经颅磁刺激, 脑电描记术