Evidence map›Paper›PMID 35297209›Full record

ArticleAnnals of clinical and translational neurology2022

Tracking cortical excitability dynamics with transcranial magnetic stimulation in focal epilepsy.

Robert M Helling, Sharon Shmuely, Prisca R Bauer, Else A Tolner, Gerhard H Visser, Roland D Thijs

Open access · goldAbstract read
In one paragraph

Article in Annals of clinical and translational neurology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
0.5field-weighted citation impact, top 38% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 6 citations in OpenAlex.

  1. Pooled it
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  3. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 5 institutions in 3 countries.

Robert M HellingStichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.ORCID 0000-0003-0277-8484
Sharon ShmuelyStichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.ORCID 0000-0001-9413-6125
Prisca R BauerDepartment of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Germany.ORCID 0000-0002-9448-6528
Else A TolnerDepartment of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.ORCID 0000-0002-6501-9971
Gerhard H VisserStichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.ORCID 0000-0001-6708-6396
Roland D ThijsStichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.ORCID 0000-0003-1435-8970
Stichting Epilepsie Instellingen Nederland · NLLeiden University · NLLeiden University Medical Center · NLUCL Biomedical Research Centre · GBUniversity Medical Center Freiburg · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe lack of reliable biomarkers constrain epilepsy management. We assessed the potential of repeated transcranial magnetic stimulation with electromyography (TMS-EMG) to track dynamical changes in cortical excitability on a within-subject basis.

methodsWe recruited people with refractory focal epilepsy who underwent video-EEG monitoring and drug tapering as part of the presurgical evaluation. We performed daily TMS-EMG measurements with additional postictal assessments 1-6 h following seizures to assess resting motor threshold (rMT), and motor evoked potentials (MEPs) with single- and paired-pulse protocols. Anti-seizure medication (ASM) regimens were recorded for the day before each measurement and expressed in proportion to the dosage before tapering. Additional measurements were performed in healthy controls to evaluate day-to-day rMT variability.

resultsWe performed 77 (58 baseline, 19 postictal) measurements in 16 people with focal epilepsy and 35 in seven healthy controls. Controls showed minimal day-to-day rMT variation. Withdrawal of ASMs was associated with a lower rMT without affecting MEPs of single- and paired-pulse TMS-EMG paradigms. Postictal measurements following focal to bilateral tonic-clonic seizures demonstrated unaltered rMT and increased short interval intracortical inhibition, while measurements following focal seizures with impaired awareness showed decreased rMT's and reduced short and long interval intracortical inhibition.

conclusionSerial within-subject rMT measurements yielded reproducible, stable results in healthy controls. ASM tapering and seizures had distinct effects on TMS-EMG excitability indices in people with epilepsy. Drug tapering decreased rMT, indicating increased overall corticospinal excitability, whereas seizures affected intracortical inhibition with contrasting effects between seizure types.

Indexed as

Cortical ExcitabilityEpilepsies, PartialEpilepsyMotor CortexHumansSeizuresTranscranial Magnetic Stimulation

Identifiers

PMID35297209
PMCPMC8994988
OpenAlexW4220981573

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.