Please cite this article in press as: Brigo, F., et al., Resting motor threshold in idiopathic generalized epilepsies: A systematic review with meta-analysis. Epilepsy Res. (2012), http://dx.doi.org/10.1016/j.eplepsyres.2012.03.020 ARTICLE IN PRESS +Model EPIRES-4745; No. of Pages 11 Epilepsy Research (2012) xxx, xxx—xxx jou rn al h om epa ge: www.elsevier.com/locate/epilepsyres REVIEW Resting motor threshold in idiopathic generalized epilepsies: A systematic review with meta-analysis Francesco Brigo a,b,* , Monica Storti c , Maria Donata Benedetti a , Fabio Rossini a , Raffaele Nardone b,d , Frediano Tezzon b , Antonio Fiaschi a , Luigi Giuseppe Bongiovanni a , Paolo Manganotti a a Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy b Division of Neurology, Hospital ‘‘Franz Tappeiner’’, Merano, Italy c Department of Medicine, University of Verona, Italy d Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria Received 30 January 2012; received in revised form 13 March 2012; accepted 28 March 2012 KEYWORDS Idiopathic generalized epilepsy; Juvenile myoclonic epilepsy; Resting motor threshold; Systematic review/meta analysis; Transcranial magnetic stimulation Summary Resting motor threshold (rMT) assessed by means of Transcranial Magnetic Stimula- tion (TMS) is thought to reflect trans-synaptic excitability of cortico-spinal neurons. TMS studies reporting rMT in idiopathic generalized epilepsies (IGEs) yielded discrepant results, so that it is difficult to draw a definitive conclusion on cortico-spinal excitability in IGEs by simple sum- mation of previous results regarding this measure. Our purpose was to carry out a systematic review and a meta-analysis of studies evaluating rMT values obtained during single-pulse TMS in patients with IGEs. Controlled studies measuring rMT by single-pulse TMS in drug-naive patients older than 12 years affected by IGEs were systematically reviewed. rMT values were assessed calculating mean difference and odds ratio with 95% confidence intervals (CI). Fourteen tri- als (265 epileptic patients and 424 controls) were included. Patients with juvenile myoclonic epilepsy (JME) have a statistically significant lower rMT compared with controls (mean differ- ence: -6.78; 95% CI -10.55 to -3.00); when considering all subtypes of IGEs and IGEs other than JME no statistically significant differences were found. Overall considered, the results are indicative of a cortico-spinal hyper-excitability in JME, providing not enough evidence for motor hyper-excitability in other subtypes of IGE. The considerable variability across studies probably reflects the presence of relevant clinical and methodological heterogeneity, and higher tempo- ral variability among rMT measurements over time, related to unstable cortical excitability in these patients. © 2012 Elsevier B.V. All rights reserved. ∗ Corresponding author at: Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy, Piazzale L.A. Scuro 10, 37134 Verona, Italy. Tel.: +39 045 8124174; fax: +39 045 8124873. E-mail address: dr.francescobrigo@gmail.com (F. Brigo). 0920-1211/$ — see front matter © 2012 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.eplepsyres.2012.03.020