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Focal panoramic radiographic findings of sclerosis and surface irregularity correlate with clinical sites of BONJ. This may be a useful and reliable tool to detect early changes of BONJ or to confirm a clinical diagnosis.

RATIONALE Repetitive transcranial magnetic stimulation (rTMS) is a technique for noninvasive focal brain stimulation where small intracranial electrical currents are generated by a fluctuating extracranial magnetic field. In clinical epilepsy rTMS has been applied most often interictally to reduce seizure frequency. Less often, rTMS has been used to terminate ongoing seizures, as in instances of epilepsia partialis continua (EPC). Whether ictal rTMS is effective and safe in treatment of EPC has not been extensively studied. Here, we report our recent experience with rTMS in treatment of EPC, as an early step towards evaluating the safety and efficacy of rTMS in the treatment of intractable ongoing focal seizures. METHODS Seven patients with EPC due to mixed etiologies were treated with rTMS applied over the seizure. rTMS was delivered in high frequency (20 to 100 Hz) bursts or as prolonged low frequency (1 Hz) trains. EEG was recorded in three of seven. RESULTS rTMS resulted in a brief (20 – 30 minutes) pause in seizures in three of seven patients and a lasting (≥ 1 day) pause in two of seven. A literature search identified six additional reports of EPC treated rTMS where seizures were suppressed in three of six. Seizures were not exacerbated by rTMS in any patient. Generally mild side-effects included transient head and limb pain, and limb stiffening during high-frequency rTMS trains. CONCLUSIONS Our clinical observations in a small number of patients suggest that rTMS may be safe and effective in suppressing ongoing seizures associated with EPC. However, a controlled trial is needed to assess the safety and anticonvulsive efficacy of rTMS in EPC treatment.

Objective-Low-frequency repetitive transcranial magnetic stimulation (rTMS) is emerging as a therapeutic tool in epilepsy. In recent years, several open-label trials have shown an encouraging reduction in seizure frequency in patients with epilepsy. However, the data from controlled trials are mixed with respect to antiepileptic rTMS efficacy, and the field would benefit from further carefully controlled trials. Prior to initiating new trials, it is important assess the magnitude of the placebo effect of presently used sham rTMS methods.Methods-We systematically analyzed individual subject data from three placebo-controlled trials and measured the placebo effect at follow-up intervals of 2, 4, and 8 weeks after sham rTMS treatment. Given the relatively small subgroup sample size, placebo condition data were pooled for analysis.Results-Three methods for sham rTMS were employed in the reviewed studies: (1) coil positioning orthogonal to the scalp, (2) a spring-loaded sham coil, and (3) a double active-sham coil. The placebo response overall was consistently low across follow-up intervals, both for median change in seizure frequency (Kruskal-Wallis, P>0.4, df = 2) and for responder (defined as ≥50% seizure frequency reduction) rate (Fisher's exact rest, P>0.9, df = 2). The aggregate effect of the placebo condition was a 0-2% median seizure reduction rate and a responder rate of 16-20%.Conclusion-We anticipate that these data will contribute to future power analysis as well as selection and design of sham rTMS methods for controlled rTMS trials.