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Repetitive transcranial magnetic stimulation for refractory and super-refractory status epilepticus : a systematic review

Chloé Algoet (UGent) , Kato Van Rooy (UGent) , Paul Boon (UGent) , Evelien Carrette (UGent) , Sofie Carrette (UGent) , Mathieu Sprengers (UGent) , Robrecht Raedt (UGent) , Ann Mertens (UGent) , Alfred Meurs (UGent) and Kristl Vonck (UGent)
(2026) NEUROMODULATION. 29(2). p.205-218
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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, EPILEPSIA PARTIALIS CONTINUA, ELECTROCONVULSIVE-THERAPY, GRADE, QUALITY, POLYMORPHISM, STRENGTH

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MLA
Algoet, Chloé, et al. “Repetitive Transcranial Magnetic Stimulation for Refractory and Super-Refractory Status Epilepticus : A Systematic Review.” NEUROMODULATION, vol. 29, no. 2, 2026, pp. 205–18, doi:10.1016/j.neurom.2025.02.001.
APA
Algoet, C., Van Rooy, K., Boon, P., Carrette, E., Carrette, S., Sprengers, M., … Vonck, K. (2026). Repetitive transcranial magnetic stimulation for refractory and super-refractory status epilepticus : a systematic review. NEUROMODULATION, 29(2), 205–218. https://doi.org/10.1016/j.neurom.2025.02.001
Chicago author-date
Algoet, Chloé, Kato Van Rooy, Paul Boon, Evelien Carrette, Sofie Carrette, Mathieu Sprengers, Robrecht Raedt, Ann Mertens, Alfred Meurs, and Kristl Vonck. 2026. “Repetitive Transcranial Magnetic Stimulation for Refractory and Super-Refractory Status Epilepticus : A Systematic Review.” NEUROMODULATION 29 (2): 205–18. https://doi.org/10.1016/j.neurom.2025.02.001.
Chicago author-date (all authors)
Algoet, Chloé, Kato Van Rooy, Paul Boon, Evelien Carrette, Sofie Carrette, Mathieu Sprengers, Robrecht Raedt, Ann Mertens, Alfred Meurs, and Kristl Vonck. 2026. “Repetitive Transcranial Magnetic Stimulation for Refractory and Super-Refractory Status Epilepticus : A Systematic Review.” NEUROMODULATION 29 (2): 205–218. doi:10.1016/j.neurom.2025.02.001.
Vancouver
1.
Algoet C, Van Rooy K, Boon P, Carrette E, Carrette S, Sprengers M, et al. Repetitive transcranial magnetic stimulation for refractory and super-refractory status epilepticus : a systematic review. NEUROMODULATION. 2026;29(2):205–18.
IEEE
[1]
C. Algoet et al., “Repetitive transcranial magnetic stimulation for refractory and super-refractory status epilepticus : a systematic review,” NEUROMODULATION, vol. 29, no. 2, pp. 205–218, 2026.
@article{01JSEBXZERNKFAM07AJ6JG8737,
  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.}},
  author       = {{Algoet, Chloé and Van Rooy, Kato and Boon, Paul and Carrette, Evelien and Carrette, Sofie and Sprengers, Mathieu and Raedt, Robrecht and Mertens, Ann and Meurs, Alfred and Vonck, Kristl}},
  issn         = {{1094-7159}},
  journal      = {{NEUROMODULATION}},
  keywords     = {{Efficacy,epilepsia partialis continua,refractory status epilepticus,superrefractory status epilepticus,transcranial magnetic stimulation,EPILEPSIA PARTIALIS CONTINUA,ELECTROCONVULSIVE-THERAPY,GRADE,QUALITY,POLYMORPHISM,STRENGTH}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{205--218}},
  title        = {{Repetitive transcranial magnetic stimulation for refractory and super-refractory status epilepticus : a systematic review}},
  url          = {{http://doi.org/10.1016/j.neurom.2025.02.001}},
  volume       = {{29}},
  year         = {{2026}},
}

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