Continuous theta burst stimulation in the treatment of epilepsia partialis continua: a case series.

Background: Epilepsia partialis continua (EPC) is a medication-resistant form of focal status epilepticus (SE), causing significant morbidity. This case series explored whether continuous theta burst stimulation (cTBS) could reduce seizure activity in patients with EPC.

Methods: Three patients with motor EPC (2M/1F) underwent an accelerated cTBS protocol over four consecutive days (five 40-s trains/day, 5Hz bursts, 3 pulses at 50Hz/burst). Stimulation targeted the epileptogenic zone using a figure-of-eight coil at 80% of the resting motor threshold. Electroencephalography (EEG) was conducted before and after each session. Seizure frequency, intensity, adverse events (AEs), seizure diaries, and follow-up data were assessed.

Results: cTBS did not interrupt EPC in any patient. One patient reported a 17% reduction in seizure frequency. Another noted mild improvement in shoulder jerks, and a third reported reduced arm tension, though without clinical confirmation. EEG showed no significant changes. One patient experienced seizures during stimulation, and another reported worsening of pre-existing headaches.

Conclusion: In this small case series, a four-day accelerated cTBS protocol did not yield clinically meaningful seizure control in EPC. Further research is needed to evaluate TMS and TBS in SE and EPC, where a significant treatment gap remains.