TMS timed to interictal epileptiform discharges

Abstract

Interictal epileptiform discharges (IEDs) are pathological hypersynchronous bursts of electrical brain activity that occur between seizures in patients with epilepsy. IEDs are caused by transient brain states that are difficult to predict, making them a challenging neurophysiological and technological case for brain-state-dependent stimulation. Administering stimulation at IED onset may provide insight into the epileptic network and optimize neurostimulation therapies. Here, we assessed the feasibility of IED-triggered transcranial magnetic stimulation (TMS) in two children with self-limited epilepsy with centrotemporal spikes (SeLECTS), a common pediatric epilepsy in which IEDs emerge from the motor cortex. A convolutional neural network (CNN) was trained on the participants’ pre-recorded electroencephalography (EEG) data with IEDs annotated by an epileptologist. The CNN was integrated into an EEG-processing pipeline that classified EEG segments as “IED” or “non-IED” in real time. With this pipeline, TMS pulses were administered during IED or non-IED periods in an interleaved, randomized design. We stimulated both the motor cortex generating the IEDs and the contralateral motor cortex and tested the impact of IEDs on TMS-evoked potentials (TEPs). Our study demonstrated that TMS can be timed to IEDs and that there is a site-specific increase in TEP amplitude when stimulating during IEDs. Out of the TMS pulses aimed at an IED, 19% and 39% were successfully delivered during an IED for the two participants, respectively. For future research, we propose ways to address the methodological challenges of IED-timed TMS, enabling brain-state-dependent TMS for epilepsy research and treatment.

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Cite

BibTeX RIS

BibTeX

@article{makkonen2026timed,
  title = {{TMS timed to interictal epileptiform discharges}},
  author = {Matilda Makkonen and Olli-Pekka Kahilakoski and Miguel Menchaca and Ivan Zubarev and Oula Siljamo and Umair Hassan and Xiwei She and Wendy Qi and Tuomas P. Mutanen and Risto J. Ilmoniemi and Pantelis Lioumis and Fiona M. Baumer},
  journal = {Scientific Reports},
  year = {2026},
  month = oct,
  doi = {10.1038/s41598-026-73986-7},
  url = {https://www.nature.com/articles/s41598-026-73986-7},
  note = {CC BY 4.0},
}

RIS

TY  - JOUR
TI  - TMS timed to interictal epileptiform discharges
AU  - Matilda Makkonen
AU  - Olli-Pekka Kahilakoski
AU  - Miguel Menchaca
AU  - Ivan Zubarev
AU  - Oula Siljamo
AU  - Umair Hassan
AU  - Xiwei She
AU  - Wendy Qi
AU  - Tuomas P. Mutanen
AU  - Risto J. Ilmoniemi
AU  - Pantelis Lioumis
AU  - Fiona M. Baumer
PY  - 2026
DA  - 2026/10/13
JO  - Scientific Reports
DO  - 10.1038/s41598-026-73986-7
UR  - https://www.nature.com/articles/s41598-026-73986-7
AB  - Interictal epileptiform discharges (IEDs) are pathological hypersynchronous bursts of electrical brain activity that occur between seizures in patients with epilepsy. IEDs are caused by transient brain states that are difficult to predict, making them a challenging neurophysiological and technological case for brain-state-dependent stimulation. Administering stimulation at IED onset may provide insight into the epileptic network and optimize neurostimulation therapies. Here, we assessed the feasibility of IED-triggered transcranial magnetic stimulation (TMS) in two children with self-limited epilepsy with centrotemporal spikes (SeLECTS), a common pediatric epilepsy in which IEDs emerge from the motor cortex. A convolutional neural network (CNN) was trained on the participants’ pre-recorded electroencephalography (EEG) data with IEDs annotated by an epileptologist. The CNN was integrated into an EEG-processing pipeline that classified EEG segments as “IED” or “non-IED” in real time. With this pipeline, TMS pulses were administered during IED or non-IED periods in an interleaved, randomized design. We stimulated both the motor cortex generating the IEDs and the contralateral motor cortex and tested the impact of IEDs on TMS-evoked potentials (TEPs). Our study demonstrated that TMS can be timed to IEDs and that there is a site-specific increase in TEP amplitude when stimulating during IEDs. Out of the TMS pulses aimed at an IED, 19% and 39% were successfully delivered during an IED for the two participants, respectively. For future research, we propose ways to address the methodological challenges of IED-timed TMS, enabling brain-state-dependent TMS for epilepsy research and treatment.
SN  - 2045-2322
ER  -

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