Skip to content
DraconiticResearch
Search Sources API
194,230 studies31 sourcesUpdated 7 min ago
Peer-reviewedCC BY 4.0Frontiers in Neurology

Bilateral cerebellar high-frequency rTMS for refractory epilepsy: a randomized, single-blind, sham-controlled study

  • Anru Liu1
  • Lin Li2
  • Yuxiang Han3
  • Lijun Wan3
  • Juntao Zhang3
  • Kejun Zang4
  • Xuewu Liu1,3
4 affiliations
  1. 1Department of Neurology, Shandong Provincial Hospital, Shandong University
  2. 2Department of Neurology, Qilu Hospital, Shandong University
  3. 3Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University
  4. 4Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine
Open at sourceDOICite

Abstract

Background: For patients with drug-resistant epilepsy who are not suitable for surgery, transcranial magnetic stimulation (TMS) is an important non-invasive neuromodulation therapy. The cerebellar cortex can inhibit cortical excitability via the cerebello-thalamo-cortical pathway. Here, we explore whether high-frequency (20 Hz) cerebellar repetitive TMS (rTMS) reduces seizure frequency and interictal epileptiform discharges (IEDs) in refractory epilepsy.

Methods: Eighty-seven patients with refractory epilepsy were included in the intention-to-treat (ITT) population ( n = 87) and then randomized to active rTMS ( n = 44) or sham stimulation ( n = 43). One patient in treatment group had no post-baseline efficacy data; efficacy analyses were therefore performed in the modified intention-to-treat (mITT) population ( n = 86). The active group received two cycles of 20 Hz rTMS targeting the cerebellum. Seizure frequency and IEDs were assessed before and after treatment.

Results: Poisson generalized linear mixed models revealed a significant group×time interaction for seizure frequency [ F (2,236) = 162.65, p < 0.001]. The active group had significantly lower seizure frequencies at months 1, 2, and 3 (all p < 0.001), with the largest difference at month 2. Percentage reductions of seizure frequency in the active group were 64.6%, 73.2%, and 13.3%, respectively, compared with 3.9%, 0.6%, and −8.4% in the control group (all P < 0.001). Responder rates (≥50% reduction) in the active group were 90.7%, 95.3%, and 0% vs. 0% in controls ( p < 0.001 for months 1–2). Within-group analysis showed significant IED reduction after active rTMS ( p < 0.001) but no change in controls. Moreover, a significant group × baseline interaction ( p < 0.001) indicated greater suppression in patients with higher baseline IEDs. Exploratory subgroup analysis further confirmed this. All adverse events were mild, with no significant difference in the incidence between the two groups.

Conclusion: Active cerebellar rTMS was associated with reduced seizure frequency, improved responder rates, and suppressed IEDs in refractory epilepsy with no obvious discomfort. The optimal efficacy duration was approximately 2 months, with greater IED suppression in patients with higher baseline levels.

Related

  1. Personalized assistive EMG-controlled virtual reality interface combined with cerebellar-iTBS for post-stroke arm recovery (ERICA): study protocol for a three-arm randomized controlled trial
    Matteo Nocilli, Alex Martino Cinnera, Danny Adrian Spampinato +5
    TrialsPeer-reviewedCC BY-NC-ND 4.0Clinical trials & evidence synthesisCrossref
  2. Advantage of cerebellar intermittent theta-burst stimulation in Alzheimer's disease (ACT-AD): study protocol for a multicenter, randomized, double-blind, sham-controlled trial
    Xin Zhang, Wen Li, Zhongqing Sun +12
    TrialsPeer-reviewedCC BY 4.0Full textNeurologyCrossref
  3. Cerebellar Continuous Theta Burst Stimulation for Insomnia Disorder: A Randomized Sham‐Controlled Trial
    Xin‐Yao Liu, Dong Dong, Chang‐Geng Song +9
    CNS Neuroscience & TherapeuticsPeer-reviewedCC BY 4.0Full textNeurologyPMCEurope PMC
  4. Bilateral Erector Spinae Plane Block With 0.375% Ropivacaine and Postoperative Analgesia After Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Cohort Study.
    Kenny Omar Contreras Becerra, Jesus Alberto Sanson-Riofrio, Juan Manuel Lopez Diaz +4
    CureusPeer-reviewedCC BYFull textSurgery & anaesthesiaEurope PMCPMC
  5. Efficacy of the Peritoneovenous Shunt as Palliative Care for Patients with Advanced Cancer with Refractory Ascites: A Randomized Controlled Trial (JIVROSG-0803 Study).
    Yasuaki Arai, Miyuki Sone, Yoshito Takeuchi +5
    Interventional radiology (Higashimatsuyama-shi (Japan)Peer-reviewedCC BY-NCFull textSurgery & anaesthesiaEurope PMC

Cite

BibTeXRIS
BibTeX
@article{liu2026bilateral,
  title = {{Bilateral cerebellar high-frequency rTMS for refractory epilepsy: a randomized, single-blind, sham-controlled study}},
  author = {Anru Liu and Lin Li and Yuxiang Han and Lijun Wan and Juntao Zhang and Kejun Zang and Xuewu Liu},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1952421},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1952421/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Bilateral cerebellar high-frequency rTMS for refractory epilepsy: a randomized, single-blind, sham-controlled study
AU  - Anru Liu
AU  - Lin Li
AU  - Yuxiang Han
AU  - Lijun Wan
AU  - Juntao Zhang
AU  - Kejun Zang
AU  - Xuewu Liu
PY  - 2026
DA  - 2026/10/29
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1952421
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1952421/full
AB  - Background: For patients with drug-resistant epilepsy who are not suitable for surgery, transcranial magnetic stimulation (TMS) is an important non-invasive neuromodulation therapy. The cerebellar cortex can inhibit cortical excitability via the cerebello-thalamo-cortical pathway. Here, we explore whether high-frequency (20 Hz) cerebellar repetitive TMS (rTMS) reduces seizure frequency and interictal epileptiform discharges (IEDs) in refractory epilepsy.  Methods: Eighty-seven patients with refractory epilepsy were included in the intention-to-treat (ITT) population ( n = 87) and then randomized to active rTMS ( n = 44) or sham stimulation ( n = 43). One patient in treatment group had no post-baseline efficacy data; efficacy analyses were therefore performed in the modified intention-to-treat (mITT) population ( n = 86). The active group received two cycles of 20 Hz rTMS targeting the cerebellum. Seizure frequency and IEDs were assessed before and after treatment.  Results: Poisson generalized linear mixed models revealed a significant group×time interaction for seizure frequency [ F (2,236) = 162.65, p < 0.001]. The active group had significantly lower seizure frequencies at months 1, 2, and 3 (all p < 0.001), with the largest difference at month 2. Percentage reductions of seizure frequency in the active group were 64.6%, 73.2%, and 13.3%, respectively, compared with 3.9%, 0.6%, and −8.4% in the control group (all P < 0.001). Responder rates (≥50% reduction) in the active group were 90.7%, 95.3%, and 0% vs. 0% in controls ( p < 0.001 for months 1–2). Within-group analysis showed significant IED reduction after active rTMS ( p < 0.001) but no change in controls. Moreover, a significant group × baseline interaction ( p < 0.001) indicated greater suppression in patients with higher baseline IEDs. Exploratory subgroup analysis further confirmed this. All adverse events were mild, with no significant difference in the incidence between the two groups.  Conclusion: Active cerebellar rTMS was associated with reduced seizure frequency, improved responder rates, and suppressed IEDs in refractory epilepsy with no obvious discomfort. The optimal efficacy duration was approximately 2 months, with greater IED suppression in patients with higher baseline levels.
SN  - 1664-2295
ER  -