Source: https://dokumentis.com/new-perspectives-in-transcranial-magnetic-stimulation-epilep.html
Timestamp: 2019-04-25 08:18:22+00:00

Document:
of brain excitability can be obtained. TMS parameters of cortical excitability depend on the stimulation paradigm (single pulse or paired pulse). Single-pulse TMS paradigm evaluates the motor threshold (MT), the motor evoked response amplitude and the cortical silent period (CSP), whereas short intracortical inhibition (SICI), short intracortical facilitation (SICF) and long intracortical inhibition (LICI) are investigated with paired-pulse TMS. The motor threshold is the minimal threshold intensity needed to obtain a motor response. Given a stable spinal motor excitability, MT is thought to represent a measure of pyramidal neuron membrane excitability . Progressive increments in pulse intensity generate a recruitment curve: the resulting modulation of motor evoked potential (MEP) amplitude to an increasing intensity of TMS pulses provides a measure of excitatory feedback to corticospinal output, chiefly mediated by glutamate [3,4].
EEG algorithm. On a finer temporal scale, TMS-EEG may enable time-locking of TMS to a specific phase of an underlying EEG signal while testing the time course of EEG reactivity to the magnetic pulse [46,47, 61,62]. Recently, time-frequency analysis has led to a better understanding of the effect of brain stimulation on brain oscillatory rhythms, with a rapid desynchronization of activity in the alpha and beta bands and a rapid synchronization of delta and theta activity . TMS-compatible scalp EEG electrodes and electronic components designed to minimize TMS artifacts are relatively inexpensive and can be adapted to most existing clinical and research EEG setups for real-time EEG recording during TMS/rTMS . The possible applications of TMS-EEG recording include diagnostic measurement of cortical excitability, real-time monitoring for epileptiform EEG activity during rTMS in vulnerable populations, and designing therapeutic rTMS protocols.
2. TMS and antiepileptic drugs Our understanding of the TMS mode of action derives, beyond the basic neurophysiological principles underpinning it, from the study of the interaction of drugs with a known mechanism of action and TMS parameters. Well-defined TMS measures are helpful tools to define the mode of action of a study drug. Applying this knowledge to a pathologically excitable brain and observing the drug-induced modulations could point to an underlying dysfunction. As far as this review is concerned, there is a wealth of data on the effects of antiepileptic drugs (AEDs) on TMS parameters.
circuits  are mediated by excitatory neurotransmitters such as NMDA receptors  and a weak inhibition mediated by GABAA receptors . Based on these findings, ICF decreases with GABAA agonists such as the benzodiazepines [2,76], and with NMDA agonists [20,91]. Finally, SICF is thought to act on the excitatory interneurons that are depolarized by the first pulse but have not yet fired. Thus, GABAA drugs (BDZ) or increased GABA amounts (gabapentin [GBP]) reduce SICF [86,88,92], given that the first pulse elicits GABAA-dependent IPSPs. Several studies focused on the interaction of AEDs and repetitive TMS (rTMS) [93,94]. Given that highfrequency rTMS (5Hz) progressively increases the size of MEPs and the duration of the CSP, the observation that CBZ, GBP and topiramate (TPM) abolish the rTMS facilitation of MEPs but do not act on the CSP leads to postulate a selective effect of rTMS on excitatory intracortical interneurons, probably by interfering with rTMS-induced synaptic potentiation. A study by Palermo et al.  in migraine patients, evaluating the phosphene threshold with 1 Hz rTMS, suggested a GABAergic modulatory mechanism of VPA that restored inhibitory intracortical circuits. 3. TMS and anesthetics Numerous studies have investigated intraoperative anesthetics and their effects on neurophysiological parameters monitored during surgery. These are mainly MEPs and sensory evoked potentials (SEPs). In the surgical setting, the former are evoked mostly by transcranial electrical stimulation (TES) and not standard TMS, given that the TES device is more manageable – less bulky and with electrodes fixed on the head of the patient. In such settings, MEP evaluation involves amplitude modifications of the potential; and the influence on these parameters of anesthetics is important for correctly evaluating the observed response. To our knowledge, only one experimental study by Ferrarelli et al.  investigated the effect of TMS and midazolam-induced anesthesia, describing a decrease in cortical effective connectivity in comparison to the wake state in healthy individuals. The decreased effective cortical connectivity was described by the authors as a restriction of the cortical areas where the TMS-induced waves were recorded, and a modulation of its duration and intensity. Interestingly, another paper by the same group  showed a similar pattern, neurophysiologically bridging the two states.
ports on the effect of TMS delivered inside a paroxysmal activity, with the stimulus evoked by either peripheral stimulation  or spontaneous . Some studies used a TMS-EEG system to avoid delivering TMS during spike and wave activity and to test motor excitability outside paroxysmal activity . In generalized epilepsy with the typical burst of 3 Hz spikes and waves, there are usually transitory periods of loss of consciousness without more complex epileptic phenomena. In other forms of epilepsy, such as Janz syndrome epilepsy or focal epilepsy, diverse and distinct episodes of loss of consciousness can occur. What remains to be discovered is the possible causal relationship between different levels of cortical excitability and its prevalent cortical localization, and the degree of consciousness impairment. 7. Future directions TMS-EEG allows the investigation of brain excitability correlated to paroxysmal activity and to episodes of loss of consciousness in epileptic patients. The possibility to deliver a magnetic pulse before or during symptomatic or asymptomatic discharges monitored by TMS-EEG will be a further step toward understanding the level of integration of the thalamocortical system. The study of sleep in epilepsy by brain stimulation is an open field where the introduction of the perturbation method during sleep could add important information on the integration and connectivity of cerebral circuitry in epilepsy. The study of focal seizures and focal paroxysms by means of TMS can drive important advances in the clinical setting, where translational methods are evolving. 8. Conclusions At present, the clinical role of TMS-EEG in epilepsy is uncertain, and a discussion of its applications in the clinical arena is necessarily speculative. However, recent data suggest that exploration in patient populations is warranted, and the adaptation of TMS-EEG to translational research may help to clarify its role as a diagnostic or therapeutic tool. Especially attractive in clinical epilepsy are the prospects for TMS-EEG as a way to test regional cortical excitability, to more accurately detect an activation thresholds for the extramotor cortex and to determine an anticonvulsive effect or a proconvulsive side effect of repetitive stimulation. As the necessary technology for TMS-EEG is now widely available, meaningful clinical and translational trials in the near future seem likely.
M. Kobayashi and A. Pascual-Leone, Transcranial magnetic stimulation in neurology, Lancet Neurol 2 (2003), 145–156. U. Ziemann, J.C. Rothwell and M.C. Ridding, Interaction between intracortical inhibition and facilitation in human motor cortex, J Physiol 496 (1996), 873–881. A. Kaelin-Lang, A.R. Luft, L. Sawaki, A.H. Burstein, Y.H. Sohn and L.G. Cohen, Modulation of human corticomotor excitability by somatosensory input, J Physiol 540 (2002), 623–633. A.J. Prout and A.A. Eisen, The cortical silent period and amyotrophic lateral sclerosis, Muscle Nerve 17 (1994), 217– 223. M. Cincotta, A. Borgheresi, S. Lori, M. Fabbri and G. Zaccara, Interictal inhibitory mechanisms in patients with cryptogenic motor cortex epilepsy: A study of the silent period following transcranial magnetic stimulation, Electroencephalogr Clin Neurophysiol 107 (1998), 1–7. F. Baldissera and P. Cavallari, Short-latency subliminal effects of transcranial magnetic stimulation on forearm motoneurones, Exp Brain Res 96 (1993), 513–518. A. Uncini, M. Treviso, A. Di Muzio, P. Simone and S. Pullman, Physiological basis of voluntary activity inhibition induced by transcranial cortical stimulation, Electroencephalogr Clin Neurophysiol 89 (1993), 211–220. M. Hallett, The plastic brain, Ann Neurol 38 (1995), 4–5. T. Kujirai, M.D. Caramia, J.C. Rothwell, B.L. Day, P.D. Thompson, A. Ferbert, S. Wroe, P. Asselman and C.D. Marsden, Corticocortical inhibition in human motor cortex, J Physiol 471 (1993), 501–519. S.H. Peurala, J.F. M¨uller-Dahlhaus, N. Arai and U. Ziemann, Interference of short-interval intracortical inhibition (SICI) and short-interval intracortical facilitation (SICF), Clin Neurophysiol 119 (2008), 2291–2297. V. Di Lazzaro, F. Pilato, M. Dileone, F. Ranieri, V. Ricci, P. Profice, P. Bria, P.A. Tonali and U. Ziemann, GABAA receptor subtype specific enhancement of inhibition in human motor cortex, J Physiol 575 (2006 Sep), 721–726. V. Di Lazzaro, A. Oliviero, M. Meglio, B. Cioni, G. Tamburrini, P. Tonali and J.C. Rothwell, Direct demonstration of the effect of lorazepam on the excitability of the human motor cortex, Clin Neurophysiol 111 (2000), 794–799. U. Ziemann, S. L¨onnecker, B.J. Steinhoff and W. Paulus, Effects of antiepileptic drugs on motor cortex excitability in humans: A transcranial magnetic stimulation study, Ann Neurol 40 (1996), 367–378. J. Florian, M. M¨uller-Dahlhaus, Y. Liu and U. Ziemann, J Physiol 586 (2008), 495–514. Inhibitory circuits and the nature of their interactions in the human motor cortex a pharmacological TMS study. P. Kreuzer, B. Langguth, R. Popp, R. Raster, V. Busch, E. Frank, G. Hajak and M. Landgrebe, Reduced intra-cortical inhibition after sleep deprivation: A transcranial magnetic stimulation study, Neurosci Lett 493 (2011), 63–66. S.H. Doeltgen, Ridding, Behavioural exposure and sleep do not modify corticospinal and intracortical excitability in the human motor system, Clin Neurophysiol 121 (2010), 448– 452. M. Avesani, E. Formaggio, G. Fuggetta, A. Fiaschi and P. Manganotti, Corticospinal excitability in human subjects during nonrapid eye movement sleep: Single and paired-pulse transcranial magnetic stimulation study, Exp Brain Res 187 (2008), 17–23.
M. McGinley, R.L. Hoffman, D.W. Russ, J.S. Thomas and B.C. Clark, Older adults exhibit more intracortical inhibition and less intracortical facilitation than young adults, Exp Gerontol 45 (2010), 671–678. M.I. Garry and R.H. Thomson, The effect of test TMS intensity on short-interval intracortical inhibition in different excitability states, Exp Brain Res 193 (2009), 267–274. P. Schwenkreis, K. Witscher, F. Janssen, A. Addo, R. Dertwinkel, M. Zenz, J.P. Malin and M. Tegenthoff, Influence of the N-methyl-D-aspartate antagonist memantine on human motor cortex excitability, Neurosci Lett 270 (1999), 137–140. U. Ziemann, R. Chen, L.G. Cohen and M. Hallett, Dextromethorphan decreases the excitability of the human motor cortex, Neurology 51 (1998), 1320–1324. R. Nardone, J. Bergmann, M. Kronbichler, F. Caleri, P. Lochner, F. Tezzon, G. Ladurner and S. Golaszewski, Altered motor cortex excitability to magnetic stimulation in alcohol withdrawal syndrome, Alcohol Clin Exp Res 34 (2010), 628–632. R. Hanajima, Y. Ugawa, Y. Terao, K. Sakai, T. Furubayashi, K. Machii and I. Kanazawa, Paired-pulse magnetic stimulation of the human motor cortex: differences among I waves, J Physiol 509 (1998), 607–618. U. Ziemann, F. Tergau, S. Wischer, J. Hildebrandt and W. Paulus, Pharmacological control of facilitatory I-wave interaction in the human motor cortex. A paired transcranial magnetic stimulation study, Electroencephalogr Clin Neurophysiol 109 (1998), 321–330. H. Tokimura, M.C. Ridding, Y. Tokimura, V.E. Amassian and J.C. Rothwell, Short latency facilitation between pairs of threshold magnetic stimuli applied to human motor cortex, Electroencephalogr Clin Neurophysiol 101 (1996), 263–272. R. Hanajima, Y. Ugawa, Y. Terao, H. Enomoto, Y. Shiio, H. Mochizuki, T. Furubayashi, H. Uesugi, N.K. Iwata and I. Kanazawa, Mechanisms of intracortical I-wave facilitation elicited with paired-pulse magnetic stimulation in humans, J Physiol 538 (2002), 253–261. `ı J. Valls-Sol´e, A. Pascual-Leone, E.M. Wassermann and M. Hallett, Human motor evoked responses to paired transcranial magnetic stimuli, Electroencephalogr Clin Neurophysiol 85 (1992), 355–364. Z.J. Daskalakis, B.K. Christensen, P.B. Fitzgerald and R. Chen, Transcranial magnetic stimulation: A new investigational and treatment tool in psychiatry, J Neuropsychiatry Clin Neurosci 14 (2002), 406–415. Review. P.B. Fitzgerald, J.J. Maller, K. Hoy, F. Farzan and Z.J. Daskalakis, GABA and cortical inhibition in motor and nonmotor regions using combined TMS-EEG: A time analysis, Clin Neurophysiol 120 (2009), 1706–1710. M.N. McDonnell and M.C. Ridding, Transient motor evoked potential suppression following a complex sensorimotor task, Clin Neurophysiol 117 (2006), 1266–1272. T.D. Sanger, R.R. Garg and R. Chen, Interactions between two different inhibitory systems in the human motor cortex, J Physiol 530 (2001), 307–317. P. Manganotti and G. Zanette, Contribution of motor cortex in generation of evoked spikes in patients with benign rolandic epilepsy, Clin Neurophysiol 111 (2000), 964–974. P. Manganotti, L.G. Bongiovanni, G. Zanette and A. Fiaschi, Early and late intracortical inhibition in juvenile myoclonic epilepsy, Epilepsia 41 (2000), 1129–1138. P. Manganotti, S. Tamburin, G. Zanette and A. Fiaschi, Hyperexcitable cortical responses in progressive myoclonic epilepsy: A TMS study, Neurology 57 (2001), 1793–1799.
D.C. Reutens, A. Puce and S.F. Berkovic, Cortical hyperexcitability in progressive myoclonus epilepsy: A study with transcranial magnetic stimulation, Neurology 43 (1993), 186–192. A. Berardelli, M. Inghilleri, J.C. Rothwell, S. Romeo, A. Curr`a, F. Gilio, N. Modugno and M. Manfredi, Facilitation of muscle evoked responses after repetitive cortical stimulation in man, Exp Brain Res 122 (1998), 79–84. R. Chen, J. Classen, C. Gerloff, P. Celnik, E.M. Wassermann, M. Hallett and L.G. Cohen, Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation, Neurology 48 (1997), 1398–1403. S. Romeo, F. Gilio, F. Pedace, S. Ozkaynak, M. Inghilleri, M. Manfredi and A. Berardelli, Changes in the cortical silent period after repetitive magnetic stimulation of cortical motor areas, Exp Brain Res 135 (2000), 504–510. Y.Z. Huang, M.J. Edwards, E. Rounis, K.P. Bhatia and J.C. Rothwell, Theta burst stimulation of the human motor cortex, Neuron 45 (2005), 201–206. V. Di Lazzaro, F. Pilato, E. Saturno, A. Oliviero, M. Dileone, P. Mazzone, A. Insola, P.A. Tonali, F. Ranieri, Y.Z. Huang and J.C. Rothwell, Theta-burst repetitive transcranial magnetic stimulation suppresses specific excitatory circuits in the human motor cortex, J Physiol 565 (2005), 945–950. V. Di Lazzaro, F. Pilato, M. Dileone, P. Profice, A. Oliviero, P. Mazzone, A. Insola, F. Ranieri, M. Meglio, P.A. Tonali and J.C. Rothwell, The physiological basis of the effects of intermittent theta burst stimulation of the human motor cortex, J Physiol 586 (2008), 3871–3879. Y.Z. Huang, J.C. Rothwell, C.S. Lu, J. Wang, Y.H. Weng, S.C. Lai, W.L. Chuang, J. Hung and R.S. Chen, The effect of continuous theta burst stimulation over premotor cortex on circuits in primary motor cortex and spinal cord, Clin Neurophysiol 120 (2009), 796–801. S.M. McAllister and J.C. Rothwell, Ridding. Selective modulation of intracortical inhibition by low-intensity Theta Burst Stimulation, Clin Neurophysiol 120, 820–826. S. Rossi, M. Hallett, P.M. Rossini and A. Pascual-Leone, Safety of TMS Consensus Group. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research, Clin Neurophysiol 120 (2009), 2008–2039. Review. R.J. Ilmoniemi, J. Virtanen, J. Ruohonen, J. Karhu, A.J. Aronen, R. N¨aa¨ t¨anen and T. Katila T. Neuronal responses to magnetic stimulation reveal cortical reactivity andconnectivity, Neuroreport 8 (1997), 3537–3540. T. Paus, P.K. Sipila and A.P. Strafella, Synchronization of neuronal activity in the human primary motor cortex by transcranial magnetic stimulation: An EEG study, J Neurophysiol 86 (2001), 1983–1990. G. Thut, G. Northoff, J.R. Ives, Y. Kamitani, A. Pfennig, F. Kampmann, D.L. Schomer and A. Pascual-Leone, Effects of single pulse transcranial magnetic stimulation (TMS) on functional brain activity: A combined event-related TMS and evoked potential study, Clin Neurophysiol 114 (2003), 2071–2080. S. Komssi, H.J. Aronen, J. Huttunen, M. Kesaniemi, L. Soinne, V.V. Nikouline et al., Ipsi- and contralateral EEG reactions to transcranial magnetic stimulation, Clin Neurophysiol 113 (2002), 175–184. S. Komssi, S. Kahkonen and R.J. Ilmoniemi, The effect of stimulus intensity on brain responses evoked by transcranial magnetic stimulation, Hum Brain Mapp 21 (2004), 154–164.
P. Manganotti and A. Del Felice / New perspectives in transcranial magnetic stimulation on motorcortical neuronal excitability, J Neural Transm 116 (2009), 423–429. P. Manganotti, L.G. Bongiovanni, G. Zanette, M. Turazzini and A. Fiaschi, Cortical excitability in patients after loading doses of lamotrigine: A study with magnetic brain stimulation, Epilepsia 40 (1999), 316–321. N. Mavroudakis, J.M. Caroyer, E. Brunko and D. Zegers de Beyl, Effects of diphenylhydantoin on motor potentials evoked with magnetic stimulation, Electroencephalogr Clin Neurophysiol 93(6) (1994 Dec), 428–433. C. Solinas, Y.C. Lee and D.C. Reutens, Effect of levetiracetam on cortical excitability: A transcranial magnetic stimulation study, Eur J Neurol 15 (2008), 501–505. J. Reis, A. Wentrup, H.M. Hamer, H.H. Mueller, S. Knake, F. Tergau, W.H. Oertel and F. Rosenow, Levetiracetam influences human motor cortex excitability mainly by modulation of ion channel function – A TMS study, Epilepsy Res 62(1) (2004 Nov), 41–51. M. Siniatchkin, S. Groppa, H. Siebner and U. Stephani, A single dose of sulthiame induces a selective increase in resting motor threshold in human motor cortex: A transcranial magnetic stimulation study, Epilepsy Res 72 (2006), 18–24. V. Di Lazzaro, A. Oliviero, P. Profice, M.A. Pennisi, F. Pilato, G. Zito, M. Dileone, R. Nicoletti, P. Pasqualetti and P.A. Tonali, Ketamine increases human motor cortex excitability to transcranial magnetic stimulation, J Physiol 547 (2003), 485–496. V.E. Amassian, M. Stewart, G.J. Quirk and J.L. Rosenthal, Physiological basis of motor effects of a transient stimulus to cerebral cortex, Neurosurgery 20 (1987), 74–93. U. Ziemann and J.C. Rothwell, I-waves in motor cortex, J Clin Neurophysiol 17 (2000), 397–405. M. Inghilleri, A. Berardelli, P. Marchetti and M. Manfredi, Effects of diazepam, baclofen and thiopental on the silent period evoked by transcranial magnetic stimulation in humans, Exp Brain Res 109 (1996), 467–472. M.G. Palmieri, C. Iani, A. Scalise, M.T. Desiato, M. Loberti, S. Telera and M.D. Caramia, The effect of benzodiazepines and flumazenil on motor cortical excitability in the human brain, Brain Res 815 (1999), 192–199. E.Y. Joo, S.H. Kim, D.W. Seo and S.B. Hong, Zonisamide decreases cortical excitability in patients with idiopathic generalized epilepsy, Clin Neurophysiol 119 (2008), 1385–1392. M. Hallett, Transcranial magnetic stimulation. Negative effects, Adv Neurol 67 (1995), 107–113. Review. K.J. Werhahn, E. Kunesch, S. Noachtar, R. Benecke and J. Classen, Differential effects on motorcortical inhibition induced by blockade of GABA uptake in humans, J Physiol 517 (1999), 591–597. K. Hattemer, S. Knake, J. Reis, W.H. Oertel, F. Rosenow and H.M. Hamer, Cyclical excitability of the motor cortex in patients with catamenial epilepsy: A transcranial magnetic stimulation study, Seizure 15 (2006), 653–657. Erratum in: Seizure 16(2) (Mar 2007), 194. M. Inghilleri, A. Berardelli, G. Cruccu and M. Manfredi, Silent period evoked by transcranial stimulation of the human cortex and cervicomedullary junction, J Physiol 466 (1993), 521–534. U. Ziemann, J. Netz, A. Szel´enyi and V. H¨omberg, Spinal and supraspinal mechanisms contribute to the silent period in the contracting soleus muscle after transcranial magnetic stimulation of human motor cortex, Neurosci Lett 156 (1993), 167–171.
N. Lang, E. Sueske, A. Hasan, W. Paulus and F. Tergau, Pregabalin exerts oppositional effects on different inhibitory circuits in human motor cortex: A double-blind, placebocontrolled transcranial magnetic stimulation study, Epilepsia 47 (2006), 813–819.  U. Ziemann, S. L¨onnecker and W. Paulus, Inhibition of human motor cortex by ethanol. A transcranial magnetic stimulation study, Brain 118 (1995), 1437–1446.  T.V. Ilic, P. Jung and U. Ziemann, Subtle hemispheric asymmetry of motor cortical inhibitory tone, Clin Neurophysiol 115 (2004), 330–340.  U. Ziemann, Intracortical inhibition and facilitation in the conventional paired TMS paradigm, Electroencephalogr Clin Neurophysiol Suppl 51 (1999), 127–136.  V. Rizzo, A. Quartarone, S. Bagnato, F. Battaglia, G. Majorana and P. Girlanda, Modification of cortical excitability induced by gabapentin: A study by transcranial magnetic stimulation, Neurol Sci 22 (1999), 229–232.  G.G. Hwa and M. Avoli, Excitatory synaptic transmission mediated by NMDA and non-NMDA receptors in the superficial/middle layers of the epileptogenic human neocortex maintained in vitro, Neurosci Lett 143 (1992), 83–86.  A.E. Telfeian and B.W. Connors, Layer-specific pathways for the horizontal propagation of epileptiform discharges in neocortex, Epilepsia 39 (1998), 700–708.  U. Ziemann, M. Hallett and L.G. Cohen, Mechanisms of deafferentation-induced plasticity in human motor cortex, J Neurosci 18(17) (1998), 7000–7007.  U. Ziemann, B.J. Steinhoff, F. Tergau and W. Paulus, Transcranial magnetic stimulation: Its current role in epilepsy research, Epilepsy Res 30 (1998), 11–30. Review.  M. Inghilleri, A. Conte, V. Frasca, A. Curra’, F. Gilio, M. Manfredi and A. Berardelli, Antiepileptic drugs and cortical excitability: A study with repetitive transcranial stimulation, Exp Brain Res 154 (2004), 488–493.  M. Inghilleri, F. Gilio, A. Conte, V. Frasca, C. Marini Bettolo, E. Iacovelli, B. Gregori, M. Prencipe and A. Berardelli, Topiramate and cortical excitability in humans: A study with repetitive transcranial magnetic stimulation, Exp Brain Res 174 (2006), 667–672.  A. Palermo, B. Fierro, G. Giglia, G. Cosentino, A.R. Puma and F. Brighina, Modulation of visual cortex excitability in migraine with aura: Effects of valproate therapy, Neurosci Lett 467 (2009), 26–29.  F. Ferrarelli, M. Massimini, S. Sarasso, A. Casali, B.A. Riedner, G. Angelini, G. Tononi and R.A. Pearce, Breakdown in cortical effective connectivity during midazolam-induced loss of consciousness, Proc Natl Acad Sci U S A 107 (2010), 2681–2686.  M. Massimini, F. Ferrarelli, R. Huber, S.K. Esser, H. Singh and G. Tononi, Breakdown of cortical effective connectivity during sleep, Science 309 (2005), 2228–2232.  A. Hufnagel, C.E. Elger, H.F. Durwen et al., Activation of the epileptic focus by transcranial magnetic stimulation of thehuman brain, Ann Neurol 27 (1990), 49–60.  P. Schuler, D. Claus and H. Stefan, Hyperventilation and transcranial magnetic stimulation: two methods of activation of epileptiform EEG activity in comparison, J Clin Neurophysiol 10 (1993), 111–115.  B.J. Steinhoff, S.R. Stodieck, Z. Zivcec, R. Schreiner, C. von Maffei, H. Plendl and W. Paulus, Transcranial magnetic stimulation (TMS) of the brain in patients with mesiotemporal epileptic foci, Clin Electroencephalogr 24 (1993), 1–5.
R. Goodman, G. McKhann, K. Babu Krishnamurthy, S. Papavassiliou, C. Epstein, J. Pollard, L. Tonder, J. Grebin, R. Coffey and N. Graves, SANTE Study Group. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy, Epilepsia 51 (2010), 899–908.  F. Velasco, A.L. Velasco, M. Velasco, F. Jim´enez, J.D. Carrillo-Ruiz and G. Castro, Deep brain stimulation for treatment of the epilepsies: the centromedian thalamic target, Acta Neurochir Suppl 97 (2007), 337–342.  R.S. Fisher, S. Uematsu, G.L. Krauss, B.J. Cysyk, R. McPherson, R.P. Lesser, B. Gordon, P. Schwerdt and M. Rise, Placebo-controlled pilot study of centromedian thalamic stimulation in treatment of intractable seizures, Epilepsia 33 (1992), 841–851.  D.M. Andrade, D. Zumsteg, C. Hamani, M. Hodaie, S. Sarkissian, A.M. Lozano and R.A. Wennberg, Long-term follow-up of patients with thalamic deep brain stimulation for epilepsy, Neurology 23(66) (2006), 1571–1573.  L. Vercueil, A. Benazzouz, C. Deransart, K. Bressand, C. Marescaux, A. Depaulis and A.L. Benabid, High-frequency stimulation of the subthalamic nucleus suppresses absence seizures in the rat: Comparison with neurotoxic lesions, Epilepsy Res 31 (1998), 39–46.  S. Chabard`es, P. Kahane, L. Minotti, A. Koudsie, E. Hirsch and A.L. Benabid, Deep brain stimulation in epilepsy with particular reference to the subthalamic nucleus, Epileptic Disord 4(Suppl 3) (2002), S83–S93.  A. Handforth, A.A. DeSalles and S.E. Krahl, Deep brain stimulation of the subthalamic nucleus as adjunct treatment for refractory epilepsy, Epilepsia 47 (2006), 1239–1241.  T. Loddenkemper, A. Pan, S. Neme, K.B. Baker, A.R. Rezai, D.S. Dinner, E.B. Montgomery, Jr. and H.O. L¨uders, Deep brain stimulation in epilepsy, J Clin Neurophysiol 18 (2001), 514–532. Review.  A.L. Benabid, L. Minotti, A. Koudsi´e, A. de Saint Martin and E. Hirsch, Antiepileptic effect of high-frequency stimulation of the subthalamic nucleus (corpus luysi) in a case of medically intractable epilepsy caused by focal dysplasia: A 30-month follow-up: technical case report, Neurosurgery 50 (2002), 1385–1391; discussion 1391–2.  F. Velasco, J.D. Carrillo-Ruiz, F. Brito et al., Double-blind, randomized controlled pilot study of bilateral cerebellar stimulation for treatment of intractable motor seizures, Epilepsia 46(7) (2005), 1071–1081.  J.M. Van Buren, J.H. Wood, J. Oakley and F. Hambrecht, Preliminary evaluation of cerebellar stimulation by doubleblind stimulation and biological criteria in the treatment of epilepsy, J Neurosurg 48 (1978), 407–416.  R. Davis, Cerebellar stimulation for seizure control, in: Textbook of Stereotactic and Functional Neurosurgery, A.M. Lozano, L.G. Philip and R.T. Ronald, eds, Berlin, Germany: Springer, 2009, 282.  A. Franzini, G. Messina, C. Marras, F. Villani, R. Cordella and G. Broggi, Deep brain stimulation of two unconventional targets in refractory non-resectable epilepsy, Stereotact Funct Neurosurg 86 (2008), 373–381.  J.C. Oakley and G.A. Ojemann, Effects of chronic stimulation of the caudate nucleus on a preexisting alumina seizure focus, Exp Neurol 75 (1982), 360–367.  M. Sramka and S.A. Chkhenkeli, Clinical experience in intraoperational determination of brain inhibitory structures and application of implanted neurostimulators in epilepsy, Stereotact Funct Neurosurg (1990), 54–55: 56–59.
Vagus Nerve Stimulation Study Group, Neurology 45 (1995), 224–230. A. Rotenberg, P. Muller, D. Birnbaum, M. Harrington, J.J. Riviello, A. Pascual-Leone and F.E. Jensen, Seizure suppression by EEG-guided repetitive transcranial magnetic stimulation in the rat, Clin Neurophysiol 119 (2008), 2697–2702. A. Rotenberg, D. Depositario-Cabacar, E.H. Bae, C. Harini, A. Pascual-Leone and M. Takeoka, Transient suppression of seizures by repetitive transcranial magnetic stimulation in a case of Rasmussen’s encephalitis, Epilepsy Behav 13 (2008), 260–262. A. Rotenberg, E.H. Bae, M. Takeoka, J.M. Tormos, S.C. Schachter and A. Pascual-Leone, Repetitive transcranial magnetic stimulation in the treatment of epilepsia partialis continua, Epilepsy Behav 14 (2008), 253–257. S. Misawa, S. Kuwabara, K. Shibuya, K. Mamada and T. Hattori, Low-frequency transcranial magnetic stimulation for epilepsia partialis continua due to cortical dysplasia, J Neurol Sci 234 (2005), 37–39. O.G. Morales, M.E. Henry, M.S. Nobler, E.M. Wassermann and S.H. Lisanby, Electroconvulsive therapy and repetitive transcranial magnetic stimulation in children and adolescents: A review and report of two cases of epilepsia partialis continua, Child Adolesc Psychiatr Clin N Am 14(1) (Jan 2005), 193–210, viii–ix. Review. A. Graff-Guerrero, J. Gonz´ales-Olvera, M. Ruiz-Garc´ıa, U. Avila-Ordo˜nez, V. Vaugier and J.C. Garc´ıa-Reyna, rTMS reduces focal brain hyperperfusion in two patients with EPC, Acta Neurol Scand 109 (2004r), 290–296. W. Sun, W. Fu, W. Mao, D. Wang and Y. Wang, Lowfrequency repetitive transcranial magnetic stimulation for the treatment of refractory partial epilepsy, Clin EEG Neurosci 42 (2011), 40–44. A. Del Felice, A. Fiaschi, G.L. Bongiovanni, S. Savazzi and P. Manganotti, The sleep-deprived brain in normals and patients with juvenile myoclonic epilepsy: A perturbational approach to measuring cortical reactivity, Epilepsy Res 96 (2011), 123–131. G. Tononi, An information integration theory of consciousness, BMC Neurosci 2(5) (2004), 42. T.G. Consciousness, information integration, and the brain, Prog Brain Res 150 (2005), 109–126. Review. M. Massimini, F. Ferrarelli, S.K. Esser, B.A. Riedner, R. Huber, M. Murphy, M.J. Peterson and G. Tononi, Triggering sleep slow waves by transcranial magnetic stimulation, Proc Natl Acad Sci U S A 104 (2007), 8496–8501. M. Steriade, Slow-wave sleep: Serotonin, neuronal plasticity, and seizures, Arch Ital Biol 142 (2004), 359–367. Review. S. Komssi, S. Kahkonen and R.J. Ilmoniemi, The effect of stimulus intensity on brain responses evoked by transcranial magnetic stimulation, Hum Brain Mapp 21 (2004), 154–164. M. Massimini, M. Boly, A. Casali, M. Rosanova and G. Tononi, A perturbational approach for evaluating the brain’s capacity for consciousness, Prog Brain Res 177 (2009), 201– 214. F. Ferrarelli, M. Massimini, S. Sarasso, A. Casali, B.A. Riedner, G. Angelini, G. Tononi and R.A. Pearce, Breakdown in cortical effective connectivity during midazolam-induced loss of consciousness, Proc Natl Acad Sci U S A 107 (2010), 2681–2686. M. Boly, M. Massimini and G. Tononi, Theoretical approaches to the diagnosis of altered states of consciousness, Prog Brain Res 177 (2009), 383–398.
togenic localization-related epilepsy: Interictal transcranial magnetic stimulation studies, Epilepsia 41 (2000), 694–704. K.J. Werhahn, J. Lieber, J. Classen and S. Noachtar, Motor cortex excitabilityin patients with focal epilepsy, Epilepsy Res 41 (2000), 179–189. F. Salih, R. Khatami, S. Steinheimer, R. Kretz, B. Schmitz and P. Grosse, A hypothesis for how non-REM sleep might promote seizures in partial epilepsies: A transcranial magnetic stimulation study, Epilepsia 48 (2007), 1538–1542. J. Liepert and M. Tegenthoff, Transcranial magnetic stimulation of patients with a single epileptic seizure, Nervenarzt 63(8) (Aug 1992), 492–494. P. Manganotti, L.G. Bongiovanni, G. Fuggetta, G. Zanette and A. Fiaschi, Effects of sleep deprivation on cortical excitability in patients affected by juvenile myoclonic epilepsy: A combined transcranial magnetic stimulation and EEG study, J Neurol Neurosurg Psychiatry 77 (2006), 56–60.
Report "New perspectives in transcranial magnetic stimulation: Epilepsy, consciousness and the perturbational approach"

References: V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V.