Transcranial Alternating Current Stimulation: A Potential Risk for Genetic Generalized Epilepsy Patients (Study Case)

Abstract

Transcranial alternating current stimulation (tACS) is a re-emergent neuromodulation technique that consists in the external application of oscillating electrical currents that induces changes in cortical excitability. We present the case of a 16-year-old female with pharmaco-resistant juvenile myoclonic epilepsy to 3 antiepileptic's drugs characterized by 4 myoclonic and 20 absence seizures monthly. She received tACS at 1 mA at 3 Hz pulse train during 60 min over Fp1-Fp2 (10-20 EEG international system position) during 4 consecutive days using an Endeavor™ IOM Systems device^® (Natus Medical Incorporated, Middleton, WI, USA). At the 1-month follow-up, she reported a 75% increase in seizures frequency (only myoclonic and tonic-clonic events) and developed a 24-h myoclonic status epilepticus that resolved with oral clonazepam and intravenous valproate. At the 2-month follow-up, the patient reported a 15-day seizure-free period.

Keywords: juvenile myoclonic epilepsy; neuromodulation; transcranial alternating current stimulation.

Figure 1

Interictal sleep (N1 stage) EEG scalp recording with generalized paroxysm of poly-spikes followed by fragmented 1–1.5 Hz spike and slow-wave complexes (*) mixed with slow waves at 3–4 Hz with higher amplitude in the anterior quadrants. Filters: 0.03–70 Hz, notch: 60 Hz, sensitivity: 7 μV/mm.