Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment), inconsistency (heterogeneity in interventions), imprecise results (few small studies) and indirectness (short follow-up time).
A Cochrane review [Abstract] 1 included 7 studies with a total of 230 subjects with drug-resistant epilepsy. The longest follow-up was 8 weeks. Two of the 7 studies (n=81) showed a statistically significant reduction in seizure rate from baseline (72% and 78.9% reduction of seizures per week, respectively). The other 5 studies showed no statistically significant difference in seizure frequency following rTMS treatment compared with controls. The results of the trials were not possible to be combined in analysis due to differences in the designs of the studies. Four studies (n=159) evaluated the mean number of epileptic discharges seen on EEG during the period between seizures, and 3 of them showed a statistically significant reduction in discharges. Quality of life was not assessed in any of the studies. Adverse effects were uncommon among the studies and typically involved headache, dizziness, and tinnitus. No significant changes in medication use were found in the trials.
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