Efficacy and Safety of Repetitive Transcranial Magnetic Stimulation in Epilepsy: A Comprehensive Review

Abstract Repetitive transcranial magnetic stimulation (rTMS) is a safe, well-tolerated neuromodulation technique with proven therapeutic potential in neurological disorders. Low-frequency rTMS, in particular, has attracted considerable interest for epilepsy management. However, published evidence regarding its efficacy and adverse effects remains conflicting. This comprehensive review evaluates studies published between January 1999 and January 2026, specifically assessing the therapeutic outcomes and safety profile of rTMS in epilepsy. Beyond a conventional synthesis, our analysis incorporates a comparative assessment of sample sizes across studies and adopts a multidimensional approach to clinical evaluation. Our findings support the clinical promise of rTMS for epilepsy patients. The intervention effectively reduces interictal epileptiform discharges and exhibits a favorable safety profile: it does not impair neuropsychological function in healthy individuals, does not worsen cognitive performance—with some evidence even suggesting improvement in Stroop task performance—and serious adverse events such as provoked seizures or psychotic symptoms are exceedingly rare. The risk profile remains low across both pediatric and adult populations. Importantly, preliminary evidence indicates potential benefits for suicidal ideation, an often-overlooked comorbidity in epilepsy. Collectively, this review underscores the significant potential of rTMS in alleviating epilepsy-related complications, with uncommon and generally mild side effects. We advocate for the expanded integration of rTMS as a valuable and promising tool in future clinical research and therapeutic protocols.