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Review
. 2026 Feb;29(2):205-218.
doi: 10.1016/j.neurom.2025.02.001. Epub 2025 Mar 28.

Repetitive Transcranial Magnetic Stimulation for Refractory and Super-refractory Status Epilepticus: A Systematic Review

Chloé Algoet  1 , Kato Van Rooy  2 , Paul Boon  3 , Evelien Carrette  2 , Sofie Carrette  3 , Mathieu Sprengers  2 , Robrecht Raedt  2 , Ann Mertens  2 , Alfred Meurs  2 , Kristl Vonck  2
Affiliations
Free article
Review

Repetitive Transcranial Magnetic Stimulation for Refractory and Super-refractory Status Epilepticus: A Systematic Review

Chloé Algoet et al. Neuromodulation. 2026 Feb.
Free article

Abstract

Rationale: Off-label treatments are often considered to treat refractory status epilepticus (RSE) and superrefractory status epilepticus (SRSE). To investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) as a treatment for (S)RSE, we performed a systematic review.

Materials and methods: Cessation of (S)RSE after rTMS was extracted as the primary end point from manuscripts describing patients with (S)RSE treated with rTMS. Data relevant to epilepsy history, (S)RSE type and etiology, prior treatment for (S)RSE, prior duration of (S)RSE, rTMS parameters, number of treatment sessions, duration of rTMS protocols, latency to (S)RSE cessation, recurrence rate, adverse events, and long-term outcome were collected as secondary end points.

Results: We identified 33 patients; 17 of 33 had epilepsia partialis continua; 7 of 33 had new onset RSE. Data were incomplete in 3 of 33 regarding classification and etiology; 18 of 30 had focal motor status epilepticus (SE), 9 of 30 nonconvulsive SE, and 3 of 30 convulsive SE. The most frequent etiologies were cortical malformation (8/31), stroke (5/31), and genetic mutations (5/31). Median duration of (S)RSE before rTMS was 70 days (range: two-7300, interquartile range = 148, Q1 = 32, Q3 = 180). In 25 of 33 patients (75.8%), rTMS caused cessation of (S)RSE after zero to four days. (S)RSE recurred in eight of 17 patients (47%), for whom follow-up was available. Three deaths occurred from the underlying disease.

Conclusion: rTMS caused cessation in 75.8% of patients with (S)RSE within four days, with recurrence in 47%. To determine the therapeutic potential of rTMS for patients with (S)RSE, further studies are required given the present findings stem from level IV studies and may have reporting bias.

Keywords: Efficacy; epilepsia partialis continua; refractory status epilepticus; superrefractory status epilepticus; transcranial magnetic stimulation.

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Conflict of interest statement

Conflicts of Interest Paul Boon obtained a Bijzonder Onderzoeks Fonds (BOF) grant from Ghent University for the purchase of transcranial magnetic stimulation equipment, obtained consultancy fees from LivaNova, Medtronic, and Angelini Pharma, and participates in the advisory board of LivaNova, Synergia Medical, and Medtronic. Alfred Meurs reported a relationship with Union Chimique Belge that includes speaking and lecture fees, and travel reimbursement; and a relationship with Angelini Pharma that includes speaking and lecture fees, and travel reimbursement. Kristl Vonck obtained a BOF grant from Ghent University for the purchase of transcranial magnetic stimulation equipment, obtained consultancy fees from LivaNova, Synergia Medical, All Man Foundation, Precisis, and Angelini Pharma, and participates in the advisory board of LivaNova, Synergia Medical, Precisis, and Angelini Pharma. The remaining authors reported no conflict of interest.

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