Background & Objective: Modulation of cortical excitability by low frequency repetitive transcranial
magnetic stimulation (rTMS) has demonstrated therapeutic use in epilepsy. This study aimed to evaluate
the efficacy of low-frequency rTMS on refractory epilepsy in a group of Malaysian subjects. Methods:
Nine patients with refractory epilepsy completed the study. All patients received 10 sessions of 1Hz
rTMS (1000 pulses per session) at 90% of resting motor threshold. Outcome measures included seizure
frequency, Symptom Checklist-90 (SCL-90), Beck Depression Inventory II (BDI II) and Quality of
Life in Epilepsy-31 (QOLIE-31). Responders were defined as having ≥ 50% seizure reduction. Results:
The mean age was 33.8 years (SD 11.7), with 4 male. Three patients had mesial temporal sclerosis
(MTS); 4 with focal cortical dysplasia (FCD) and two lesion-negative. Three patients achieved >50%
seizure reduction at 8 weeks post-treatment, with 2 of them had improvement in the number of IED.
All of the responders had FCD. The responders were younger (mean 24.7 vs. 38.3 years old), had
shorter duration of illness (mean 15.7 vs. 30.5 years) and had less frequent seizure frequency prior to
treatment (mean 5.5 vs. 10.8 attacks per week), as compared to the non-responders. Six patients had
improvement in BDI-II scores, two in QOLIE-31 and four in SCL-90 post treatment, irrespective of
seizure control. The mean scores in BDI-II improved significantly with treatment (p