***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: To study the antiepileptic effects of rTMS in patients with refractory epilepsy and malformations of cortical development in a r and omized , double‐blind , sham‐controlled trial Objective To examine the prevalence of outcome reporting bias — the selection for publication of a subset of the original recorded outcome variables on the basis of the results — and its impact on Cochrane review s. Design A nine point classification system for missing outcome data in r and omised trials was developed and applied to the trials assessed in a large , unselected cohort of Cochrane systematic review s. Research ers who conducted the trials were contacted and the reason sought for the non-reporting of data . A sensitivity analysis was undertaken to assess the impact of outcome reporting bias on review s that included a single meta- analysis of the review primary outcome . Results More than half ( 157/283 ( 55 % ) ) the review s did not include full data for the review primary outcome of interest from all eligible trials . The median amount of review outcome data missing for any reason was 10 % , whereas 50 % or more of the potential data were missing in 70 ( 25 % ) review s. It was clear from the publications for 155 ( 6 % ) of the 2486 assessable trials that the research ers had measured and analysed the review primary outcome but did not report or only partially reported the results . For reports that did not mention the review primary outcome , our classification regarding the presence of outcome reporting bias was shown to have a sensitivity of 88 % ( 95 % CI 65 % to 100 % ) and specificity of 80 % ( 95 % CI 69 % to 90 % ) on the basis of responses from 62 trialists . A third of Cochrane review s ( 96/283 ( 34 % ) ) contained at least one trial with high suspicion of outcome reporting bias for the review primary outcome . In a sensitivity analysis undertaken for 81 review s with a single meta- analysis of the primary outcome of interest , the treatment effect estimate was reduced by 20 % or more in 19 ( 23 % ) . Of the 42 meta-analyses with a statistically significant result only , eight ( 19 % ) became non-significant after adjustment for outcome reporting bias and 11 ( 26 % ) would have overestimated the treatment effect by 20 % or more . Conclusions Outcome reporting bias is an under-recognised problem that affects the conclusions in a substantial proportion of Cochrane review s. Individuals conducting systematic review s need to address explicitly the issue of missing outcome data for their review to be considered a reliable source of evidence . Extra care is required during data extraction , review ers should identify when a trial reports that an outcome was measured but no results were reported or events observed , and contact with trialists should be encouraged It has been 30 years since the discovery that repeated electrical stimulation of neural pathways can lead to long-term potentiation in hippocampal slices . With its relevance to processes such as learning and memory , the technique has produced a vast literature on mechanisms of synaptic plasticity in animal models . To date , the most promising method for transferring these methods to humans is repetitive transcranial magnetic stimulation ( rTMS ) , a noninvasive method of stimulating neural pathways in the brain of conscious subjects through the intact scalp . However , effects on synaptic plasticity reported are often weak , highly variable between individuals , and rarely last longer than 30 min . Here we describe a very rapid method of conditioning the human motor cortex using rTMS that produces a controllable , consistent , long-lasting , and powerful effect on motor cortex physiology and behavior after an application period of only 20 - 190 PURPOSE To assess the effectiveness of slow repetitive transcranial magnetic stimulation ( rTMS ) as an adjunctive treatment for drug-resistant epilepsy . METHODS Forty-three patients with drug-resistant epilepsy from eight Italian Centers underwent a r and omized , double-blind , sham-controlled , crossover study on the clinical and EEG effects of slow rTMS . The stimulus frequency was 0.3 Hz . One thous and stimuli per day were given at the resting motor threshold intensity for 5 consecutive days , with a round coil at the vertex . RESULTS " Active " rTMS was no better than placebo for seizure reduction . However , it decreased interictal EEG epileptiform abnormalities significantly ( p < 0.05 ) in one-third of the patients , which supports a detectable biologic effect . No correlation linked the rTMS effects on seizure frequency to syndrome or anatomic classification , seizure type , EEG changes , or resting motor threshold ( an index of motor cortex excitability ) . CONCLUSIONS Although the antiepileptic action was not significant ( p > 0.05 ) , the individual EEG reactivity to " active " rTMS may be encouraging for the development of more-powerful , noninvasive neuromodulatory strategies OBJECTIVE To evaluate the antiepileptic effect of low-frequency rTMS ( repetitive transcranial magnetic stimulation ) in the patients with intractable epilepsy . METHODS We enrolled 35 patients with localization-related epilepsy who had experienced at least one complex partial seizure or a secondarily generalized seizure per week on a constant antiepileptic drug regimen over an 8-week period .  rTMS was administered using a Rapid(2 ) magnetic stimulator with an air-cooled coil at 0.5Hz for 5 consecutive days at 100 % of rMT ( resting motor threshold ) . Patients were divided into a focal stimulation group with a localized epileptic focus , or a non-focal stimulation group with a non-localized or multifocal epileptic focus . These two groups were then r and omly subdivided into four subgroups depending on the total number of stimulations administered , i.e. , 3000 pulse and 1500 pulse subgroups . Weekly seizure frequencies were determined for 8 weeks before and after rTMS . To compare the number of interictal spikes before and after rTMS , EEG was recorded twice before ( 1st day ) and after rTMS ( 5th day ) . RESULTS Mean weekly seizure frequency was non-significantly decreased after rTMS ( 8.4 - ->6.8/week , -13.9 % ) . Longer stimulation subgroups ( 3000 pulses , -23.0 % ) tended to have fewer seizures than shorter stimulation subgroups ( 1500 pulses , -3.0 % ) , without statistical significance . TMS stimulation site and structural brain lesions did not influence seizure outcome . However , interictal spikes significantly decreased ( -54.9 % , P=0.012 ) after rTMS and they totally disappeared in 6 patients ( 17.1 % , 6/35 ) . CONCLUSIONS Low-frequency rTMS reduced interictal spikes , but its effect on seizure outcome was not significant . Focal stimulation for a longer duration tended to further reduce seizure frequency . SIGNIFICANCE These findings may help clinicians to further investigate the therapeutic potential of the rTMS for patients with intractable epilepsy Publisher Summary Based on the findings that the effects of repetitive transcranial magnetic stimulation ( rTMS ) last beyond the period of stimulation itself , therapeutical antiepileptic potential of low-frequency rTMS was hypothesized . This chapter presents an interim analysis of an ongoing placebo-controlled trial . The results are discussed on the bases of the existing rTMS literature regarding the treatment of epilepsies in humans . The results presented in this chapter are interim analyses of the first crossover placebo-controlled investigation on the antiepileptic efficacy of low-frequency rTMS . Although a significant difference to placebo could not be demonstrated in this patient group , the data seem to be in line with the results of the first open pilot study on nine patients who showed reduction in seizure frequency within a similar range over a 4-week period . The results were supplemented by a case report on a patient with focal dysplasia by another group : biweekly treatment with 100 stimuli at 0.5 Hz and 95 % motor threshold intensity using an unfocal coil placed over the area of dysplasia reduced seizure frequency by 70 % over a 4-weeks period of treatment PURPOSE This study was design ed to evaluate the therapeutic effect of low-frequency repetitive transcranial magnetic stimulation ( rTMS ) on patients with refractory partial epilepsy . METHODS Sixty-four patients with refractory focal epilepsy were screened and 60 patients were r and omly divided into two groups by stimulation intensity : 90 % ( group 1 ) or 20 % ( group 2 ) of resting motor threshold ( rMT ) . Seizure frequency and interictal EEG epileptic discharges were compared between the baseline and follow-up periods . KEY FINDINGS Seizures significantly decreased following 2-weeks high intensity ( 90 % rMT ) rTMS treatment compared with baseline level ( p < 0.05 ) . rTMS also decreased interictal epilepsy discharges and improved the scales of Symptom Checklist-90 significantly ( p < 0.05 ) . Seizures and spikes in the follow-up period in the patients who received low intensity ( 20 % rMT ) rTMS did not show any difference compared with baseline data ( p > 0.05 , respectively ) . SIGNIFICANCE Low-frequency high intensity rTMS ( 90 % rMT ) delivered into the epileptogenic zone had a significant antiepileptic effect on patients with refractory partial seizures . rTMS treatment can also reduce the interictal epileptic discharge frequency and improve the psychological condition of these patients Objective To perform a controlled trial of transcranial magnetic stimulation ( TMS ) . Methods Twenty-four patients with localization-related epilepsy were r and omized to blinded active or placebo stimulation . Weekly seizure frequency was compared for 8 weeks before and after 1 week of 1-Hz TMS for 15 minutes twice daily . Results When the 8-week baseline and post-stimulation periods were compared , active patients had a mean seizure frequency reduction of 0.045 ± 0.13 and sham-stimulated control subjects −0.004 ± 0.20 . Over 2 weeks , actively treated patients had a mean reduction in weekly seizure frequency of 0.16 ± 0.18 and sham-stimulated control subjects 0.01 ± 0.24 . Neither difference was significant . Conclusion The effect of TMS on seizure frequency was mild and short lived 
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Adverse effects were uncommon among the studies and typically involved headache , dizziness , and tinnitus .
There is evidence that rTMS is safe and not associated with any adverse events , but given the variability in technique and outcome reporting that prevented meta- analysis , the evidence for efficacy of rTMS for seizure reduction is still lacking despite reasonable evidence that it is effective at reducing epileptiform discharges