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Transcranial magnetic stimulation/electromyography biomarker for differential diagnosis of adult patients with psychogenic nonepileptic seizure from patients with epileptic seizure and healthy subjects: An experimental study

Articles in Press

Document Type : Original Article

Authors

1 Neuroscience Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Department of Psychology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

Abstract

Background: Epilepsy is a prevalent disease worldwide which affects 1% of the global population, making it the fourth most common disease. The primary category of epilepsy, psychogenic nonepileptic seizures (PNES), can lead to significant time and financial burdens if not promptly diagnosed. Diagnosing epileptic seizures (ES) can be complex, with video electroencephalography (VEEG) monitoring, history taking, and interviews being the most effective methods. However, VEEG is costly and not always accessible.
This study aimed to develop a cost-effective diagnostic approach using transcranial magnetic stimulation (TMS)-derived indicators. The motor threshold (MT), a key brain and spinal cord excitability indicator, differentiated ES from PNES.
Methods: The study compared 24 patients with ES, 24 patients with PNES, and 24 healthy individuals in the control group, all aged between 31-57 years.
Results: The mean MT for individuals with ES and those with PNES was the same (73.5%), and there was no significant difference in the mean MT between the two groups of patients and individuals without any medical conditions (P > 0.05). The findings indicated that VEEG remained the preferred method for diagnosing various forms of epilepsy, particularly PNES.
Conclusion: The MT derived from TMS and the general assessment of motor cortex excitability may not be a suitable diagnostic criterion for distinguishing ES from PNES.

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References
  1. Giourou E, Stavropoulou-Deli A, Giannakopoulou A, Kostopoulos GK, Koutroumanidis M. Introduction to epilepsy and related brain disorders. In: Voros NS, Antonopoulos CP, Editors. Cyberphysical Systems for Epilepsy and Related Brain Disorders: Multi-parametric Monitoring and Analysis for Diagnosis and Optimal Disease Management.
    Cham, Switzerland: Springer Cham; 2015. p. 11-38.
  2. Chen T, Wang Y, He Z, Yu S, Shu H, Kuang Y. Progress in the study of the role of HMGB1 in the pathogenesis of epilepsy. Chin J Na 2018; 34(05): 643-6.
  3. Berkovic SF. Genetics of Epilepsy in Clinical Practice. Epilepsy Curr 2015; 15(4): 192-6.
  4. van Paesschen W, Dupont P, Van Driel G, Van Billoen H, Maes A. SPECT perfusion changes during complex partial seizures in patients with hippocampal sclerosis. Brain 2003; 126(Pt 5): 1103-11.
  5. Xiang X, Fang J, Guo Y. Differential diagnosis between epileptic seizures and psychogenic nonepileptic seizures based on semiology. Acta Epileptologica 2019; 1: 1-5.
  6. Anwar H, Khan QU, Nadeem N, Pervaiz I, Ali M, Cheema FF. Epileptic seizures. Discoveries (Craiova) 2020; 8(2): e110.
  7. Benbadis S. The differential diagnosis of epilepsy: A critical review. Epilepsy Behav 2009; 15(1): 15-21.
  8. Currà A, Modugno N, Inghilleri M, Manfredi M, Hallett M, Berardelli A. Transcranial magnetic stimulation techniques in clinical investigation. Neurology 2002; 59(12): 1851-9.
  9. Kim DR, Pesiridou A, O'Reardon JP. Transcranial magnetic stimulation in the treatment of psychiatric disorders. Curr Psychiatry Rep 2009; 11(6): 447-52.
  10. Rossini PM, Barker AT, Berardelli A, Caramia MD, Caruso G, Cracco RQ, et al. Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application. Report of an IFCN committee. Electroencephalogr Clin Neurophysiol 1994; 91(2): 79-92.
  11. Di Lazzaro V, Oliviero A, Profice P, Ferrara L, Saturno E, Pilato F, et al. The diagnostic value of motor evoked potentials. Clin Neurophysiol 1999; 110(7): 1297-307.
  12. Rossini PM, Rossi S. Clinical applications of motor evoked potentials. Electroencephalogr and clin Neurophysiol 1998; 106(3): 180-94.
  13. Kobayashi M, Pascual-Leone A. Transcranial magnetic stimulation in neurology. The Lancet Neurol 2003; 2(3): 145-56.
  14. Westin GG, Bassi BD, Lisanby SH, Luber B. Determination of motor threshold using visual observation overestimates transcranial magnetic stimulation dosage: safety implications. Clin Neurophysiol 2014; 125(1): 142-7.
  15. Rossini PM, Desiato MT, Caramia MD. Age-related changes of motor evoked potentials in healthy humans: non-invasive evaluation of central and peripheral motor tracts excitability and conductivity. Brain Res 1992; 593(1): 14-9.
  16. Valls-Solé J, Pascual-Leone A, Brasil-Neto J, Cammarota A, McShane L, Hallett M. Abnormal facilitation of the response to transcranial magnetic stimulation in patients with Parkinson's disease. Neurology 1994; 44(4): 735-41.
  17. Rossini PM, Burke D, Chen R, Cohen LG, Daskalakis Z, Di Iorio R, et al. Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee. Clin Neurophysiol 2015; 126(6): 1071-107.
  18. Pawley AD, Chowdhury FA, Tangwiriyasakul C, Ceronie B, Elwes RD, Nashef L, et al. Cortical excitability correlates with seizure control and epilepsy duration in chronic epilepsy. Ann Clin Transl Neurol 2017; 4(2): 87-97.
  19. Ter Braack EM, de Goede AA, van Putten M. Resting Motor Threshold, MEP and TEP Variability During Daytime. Brain Topogr 2019; 32(1): 17-27.
  20. Tataroglu C, Ozkiziltan S, Baklan B. Motor cortical thresholds and cortical silent periods in epilepsy. Seizure 2004; 13(7): 481-5.
  21. Manganotti P, Bongiovanni LG, Zanette G, Fiaschi A. Early and late intracortical inhibition in juvenile myoclonic epilepsy. Epilepsia 2000; 41(9): 1129-38.
  22. Akgun Y, Soysal A, Atakli D, Yuksel B, Dayan C, Arpaci B. Cortical excitability in juvenile myoclonic epileptic patients and their asymptomatic siblings: A transcranial magnetic stimulation study. Seizure 2009; 18(6): 387-91.
  23. Cantello R, Civardi C, Cavalli A, Varrasi C, Tarletti R, Monaco F, et al. Cortical excitability in cryptogenic localization-related epilepsy: Interictal transcranial magnetic stimulation studies. Epilepsia 2000; 41(6): 694-704.
  24. Ziemann U, Lönnecker S, Steinhoff BJ, Paulus W. Effects of antiepileptic drugs on motor cortex excitability in humans: A transcranial magnetic stimulation study. Ann Neurol 1996; 40(3): 367-78.
  25. Badawy RA, Macdonell RA, Berkovic SF, Newton MR, Jackson GD. Predicting seizure control: cortical excitability and antiepileptic medication. Ann Neurol 2010; 67(1): 64-73.
  26. Badawy RA, Jackson GD, Berkovic SF, Macdonell RA. Cortical excitability and refractory epilepsy: A three-year longitudinal transcranial magnetic stimulation study. Int J Neural Syst 2013; 23(1): 1250030.
  27. Siniatchkin M, Groppa S, Siebner H, Stephani U. A single dose of sulthiame induces a selective increase in resting motor threshold in human motor cortex: A transcranial magnetic stimulation study. Epilepsy Res 2006; 72(1): 18-24.
  28. Di Lazzaro V, Oliviero A, Profice P, Pennisi MA, Pilato F, Zito G, et al. Ketamine increases human motor cortex excitability to transcranial magnetic stimulation. J Physiol 2003; 547(Pt 2): 485-96.
  29. Stokes MG, Chambers CD, Gould IC, English T, McNaught E, McDonald O, et al. Distance-adjusted motor threshold for transcranial magnetic stimulation. Clin Neurophysiol 2007; 118(7): 1617-25.
  30. Chen R, Corwell B, Yaseen Z, Hallett M, Cohen LG. Mechanisms of cortical reorganization in lower-limb amputees. J Neurosci 1998; 18(9): 3443-50.
Current Journal of Neurology

Articles in Press, Accepted Manuscript
Available Online from 12 January 2025
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