***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 Repetitive transcranial magnetic stimulation ( rTMS ) is an emerging non-pharmacological approach to treating many brain-based disorders . rTMS uses electromagnetic coils to stimulate areas of the brain non-invasively . Deep transcranial magnetic stimulation ( dTMS ) with the Brainsway H1-coil system specifically is a type of rTMS indicated for treating patients with major depressive disorder ( MDD ) who are resistant to medication . The unique H1-coil design of this device is able to stimulate neuronal pathways that lie deeper in the targeted brain areas than those reached by conventional rTMS coils . dTMS is considered to be low-risk and well tolerated , making it a viable treatment option for people who have not responded to medication or psychotherapy trials for their depression . R and omized , sham-control studies have demonstrated that  dTMS  produces significantly greater improvement in depressive symptoms than sham dTMS treatment in patients with major depression that has not responded to antidepressant medication . In this paper , we will review the methodology for treating major depression with dTMS using an H1-coil We evaluated the effect of low-frequency repetitive transcranial magnetic stimulation ( rTMS ) on seizure frequency in adult patients with medically intractable extratemporal lobe epilepsy ( ETLE ) . Seven patients with medically intractable ETLE received low-frequency rTMS at 0.9 Hz , basically two sets of 15 min stimulation per day for five days in a week , with the stimulus intensity of 90 % of resting motor threshold ( RMT ) . The number of seizures during two weeks before and after the stimulation of one week was compared . Furthermore , RMT and active motor threshold ( AMT ) were measured before and after rTMS for each daily session . After low-frequency rTMS of one week , the frequency of all seizure types , complex partial seizures ( CPSs ) and simple partial seizures was reduced by 19.1 , 35.9 and 7.4 % , respectively . The patients with smaller difference between RMT and AMT before rTMS had higher reduction rate of CPSs . A favorable tendency of seizure reduction , though not statistically significant , during two weeks after low-frequency rTMS was demonstrated in medically intractable ETLE patients . As far as CPSs are concerned , smaller decrease of motor threshold by voluntary muscle contraction was associated with better response to rTMS PURPOSE To evaluate the number of seizures and interictal epileptiform discharges ( IEDs ) in patients with focal neocortical epilepsy before , during and after rTMS .  METHODS Twelve patients ( seven men and five women , mean age 29.3+/-15.8 years ) were studied . An open-label study with baseline ( 4 weeks ) , intervention ( 2 weeks ) and follow-up ( 8 weeks ) periods was carried out . Repetitive transcranial magnetic stimulation ( rTMS ) with 900 pulses , intensity of 120 % motor resting threshold and 0.5Hz frequency was used . A 120 channel EEG was recorded ; an  electrical source analysis of IEDs with Variable Resolution Electromagnetic Tomography ( VARETA ) was performed . The number of seizures per week and IEDs per minute were measured and compared in the three periods . RESULTS During the basal period the mean seizure frequency was 2.25 per week ; in the intervention period it decreased to 0.66 per week ( F=2.825 ; p=0.0036 ) which corresponds to a 71 % reduction . In the follow-up period the mean frequency was 1.14 seizures per week , that is , a 50 % reduction in the number of seizures . In the visual EEG analysis , the baseline IED frequency was 11.9+/-8.3events/min ; it decreased to 9.3+/-7.9 during 2 weeks of rTMS with a further reduction to 8.2+/-6.6 in the follow-up period . These differences however were not significant ( p=0.190 ) . CONCLUSION We conclude that 2 weeks of rTMS at 0.5Hz with a figure-of-eight coil placed over the epileptic focus , determined with VARETA , decreases the number of seizures in patients with focal epilepsy , without reduction in IEDs 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 Rapid-rate transcranial magnetic stimulation ( rTMS ) allows for the noninvasive examination of the cerebral cortex . Recent studies have begun to investigate whether rTMS may be therapeutic for the treatment of depression . In the present study , the authors report on the safety and efficacy of rTMS in treating 50 patients with refractory depression . Overall , there were 21 responders ( 42 % ) . Interestingly , 56 % of the young patients responded , but only 23 % of the elderly patients responded to rTMS . Overall ,  rTMS was well tolerated in all patients . Specifically , no patient developed a new onset of seizures during rTMS . The authors discuss the extant literature on rTMS for the treatment of depression along with future areas of research 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 Seventeen refractory partial epilepsy patients were enrolled in an open-label study to evaluate the antiepileptic effect of low-frequency repetitive transcranial magnetic stimulation ( rTMS ) .  Seven of the patients had not obtained seizure-free status after epileptogenic focus resection surgery before they were enrolled in the study . All patients were treated with low-frequency rTMS which included 3 sessions per day ( 0.5 Hz , 90 % RMT and 500 pulses each session ) and lasted for 2 weeks . Seizure frequency , seizure days and epileptic discharges in the EEG obtained before , during and after stimulation were compared . The psychological conditions of all individual patients were evaluated with Symptom Checklist-90 ( SCL-90 ) before and after rTMS treatment . Mean seizure frequencies per week significantly decreased in the following 4-week rTMS treatment period compared with the pretreatment period ( 14.09 vs. 5.63 , p < 0.05 , mean reduction of 60.02 % in seizure frequency ) . Mean seizure days per week during the treatment period and the post-treatment period were lower than that of the pretreatment period ( 5.18 vs. 2.99 p < 0.05 , mean reduction of 42.5 % in seizure days ) . Mean epileptic discharges in the EEG decreased significantly during the treatment period compared to that of the pre-treatment period ( 78.60 vs. 66.09 , p < 0.05 , mean reduction of 15. 
    Output:
    
Significance Real-world evidence suggests that low-frequency rTMS using a figure-8 coil may be an effective therapy for the treatment of drug-resistant epilepsy in pediatric patients .