{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T01:23:05Z","timestamp":1789780985731,"version":"4.0.1"},"reference-count":60,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epileptic Disorders"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>We performed a comprehensive systematic review and meta\u2010analysis of repetitive transcranial magnetic stimulation (rTMS) to explore its use as an adjunctive therapy for adult patients with drug\u2010resistant epilepsy (DRE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA guidelines, PubMed and Ovid MEDLINE databases were searched until January 2025 for English\u2010language studies reporting pre\u2010 and post\u2010rTMS seizure frequencies and detailed protocols in adult patients with DRE. Random\u2010effects meta\u2010analyses pooled standardized mean differences in weekly seizure frequency at immediate, 4\u2010week, and 8\u2010week follow\u2010ups. Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools, and evidence certainty was graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and Oxford Centre for Evidence\u2010Based Medicine (OCEBM) frameworks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      12 studies involving 150 participants were included, with seven contributing to the meta\u2010analysis. Meta\u2010analysis demonstrated a small but statistically significant reduction in seizure frequency at 4 and 8\u2009weeks following rTMS (pooled SMD \u2212.49 [95% CI \u2212.98 to \u2212.01,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.46] and \u2212.19 [95% CI \u2212.35 to \u2212.02,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.91]), with insignificant heterogeneity (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%). In contrast, no statistically significant difference was observed immediately after rTMS (pooled SMD .19 [95% CI \u22121.69 to 1.31,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.38]). Common adverse effects included headaches (14%\u201333%) and hearing problems (9%\u201314%). Quality of life improved significantly in two of three studies, and one study reported depression improvement in 67% of participants. Risk of bias was low in three studies, moderate in five, and high in four.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>rTMS use as adjunctive therapy for DRE demonstrated moderate (GRADE level 2) and low\u2010quality (OCEBM level 3) evidence. rTMS was associated with modest reductions in seizure frequency in selected populations. However, effect sizes were small and heterogeneous. Larger, prospective, multicenter studies are needed to further evaluate its efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>International Prospective Register of Systematic Reviews (PROSPERO) (ID #CRD42024553998).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epd2.70190","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T17:11:51Z","timestamp":1770052311000},"page":"602-622","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Repetitive transcranial magnetic stimulation as adjunctive therapy in adult patients with drug\u2010resistant epilepsy\u2014A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8087-7464","authenticated-orcid":false,"given":"Marjorie Jia 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Faculty of Medicine Universiti Kebangsaan Malaysia  Kuala Lumpur Malaysia"},{"name":"Neurology Unit, Department of Medicine Hospital Canselor Tuanku Muhriz  Kuala Lumpur Malaysia"},{"name":"Centre for Global Epilepsy, Wolfson College University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4827-7984","authenticated-orcid":false,"given":"Hui Jan","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine Universiti Kebangsaan Malaysia  Kuala Lumpur Malaysia"},{"name":"Neurology Unit, Department of Medicine Hospital Canselor Tuanku Muhriz  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6066-5168","authenticated-orcid":false,"given":"Azman Ali","family":"Raymond","sequence":"additional","affiliation":[{"name":"Department of Medicine Faculty of Medicine, UiTM, Sungai Buloh Campus  Selangor 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Salzburg Austria"},{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment University for Health Sciences, Medical Informatics, and Technology, Hall in Tyrol  Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6288-9915","authenticated-orcid":false,"given":"Adam","family":"Strzelczyk","sequence":"additional","affiliation":[{"name":"Epilepsy Center Frankfurt Rhine\u2010Main, Department of Neurology University Medical Center Frankfurt, Goethe University Frankfurt  Frankfurt am Main 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