A core feature of drug-resistant epilepsy is hyperexcitability in the motor cortex, and low-frequency repetitive transcranial magnetic stimulation (rTMS) is a suitable treatment for seizures. However, the antiepileptic effect causing network reorganization has rarely been studied. Here, we assessed the impact of rTMS on functional network connectivity (FNC) in resting functional networks (RSNs) and their relation to treatment response. Fourteen patients with medically intractable epilepsy received inhibitive rTMS with a figure-of-eight coil over the vertex for 10 days spread across two weeks. We designed a six-week follow-up phase divided into four time points to investigate FNC and rTMS-induced timing-dependent plasticity, such as seizure frequency and abnormal interictal discharges on electroencephalography (EEG). For psychiatric comorbidities, the Hamilton Depression Scale (HAM-D) and the Hamilton Anxiety Scale (HAM-A) were applied to measure depression and anxiety before and after rTMS. FNC was also compared to that of a cohort of 17 healthy control subjects. The after-effects of rTMS included a significant decrease of 75.71% in interictal epileptiform discharges and seizure frequency, with a reduction rate of 54.55% compared to the baseline, as well as emotional improvements in depression and anxiety (p < 0.05). In the analysis of RSNs, we found a higher synchronization between the sensorimotor network (SMN) and posterior default-mode network (pDMN) in epileptic patients than in healthy controls. In contrast to pre-rTMS, the results demonstrated a weaker FNC between the anterior DMN (aDMN) and SMN after rTMS, while the FNC between the aDMN and dorsal attention network (DAN) was greater (p < 0.05, FDR corrected). Importantly, the depressive score was anticorrelated with the FNC of the aDMN-SMN (r=0.6668, p=0.0022), which was markedly different in the good and bad response groups treated with rTMS (p=0.0115). Based on the vertex suppression by rTMS, it is possible to achieve temporary antiepileptic efficacy by modulating network reorganization in the DMN and SMN for patients with refractory epilepsy.

中文翻译：

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顶点抑制重复经颅磁刺激的抗癫痫功效和网络连接调制。

耐药性癫痫的核心特征是运动皮层过度兴奋，而低频重复经颅磁刺激（rTMS）是癫痫发作的合适治疗方法。但是，很少研究引起网络重组的抗癫痫作用。在这里，我们评估了rTMS对静止功能网络（RSN）中功能网络连接性（FNC）的影响及其与治疗反应的关系。14例具有医学顽固性癫痫病的患者接受了抑制性rTMS，在整个顶点分布了八天的线圈，共八周，分布在两周内。我们设计了一个为期六周的随访阶段，分为四个时间点，以研究FNC和rTMS诱导的时序依赖性可塑性，例如癫痫发作频率和脑电图（EEG）异常发作的发作间期放电。对于精神病合并症，采用汉密尔顿抑郁量表（HAM-D）和汉密尔顿焦虑量表（HAM-A）来测量rTMS前后的抑郁和焦虑。还比较了FNC与一组17名健康对照受试者的FNC。rTMS的后遗症包括发作间期癫痫样放电和癫痫发作频率显着降低75.71％，与基线相比降低率54.55％，以及抑郁症和焦虑症的情绪改善（p <0.05）。在RSN的分析中，我们发现癫痫患者的感觉运动网络（SMN）与后默认模式网络（pDMN）之间的同步性高于健康对照组。与rTMS之前的版本相反，结果表明rTMS之后，前DMN（aDMN）和SMN之间的FNC较弱，而aDMN和背侧注意网络（DAN）之间的FNC更大（p <0.05，经FDR校正）。重要的是，抑郁评分与aDMN-SMN的FNC呈反相关（r = 0.6668，p = 0.0022），在用rTMS治疗的好反应组和差反应组中差异显着（p = 0.0115）。基于rTMS抑制顶点，可以通过调节DMN和SMN中难治性癫痫患者的网络重组来获得暂时的抗癫痫功效。