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Seizures from transcranial magnetic stimulation 2012-2016: Results of a survey of active laboratories and clinics.

ABSTRACT: OBJECTIVE:Transcranial magnetic stimulation (TMS) can cause seizures in healthy individuals and patients. However, the rate at which this occurs is unknown. We estimated the risk of seizure and other adverse events with TMS. METHODS:We surveyed laboratories and clinics about seizures and other events observed between 2012 and 2016 (inclusive). Respondents (N?=?174) reported an estimated 318,560 TMS sessions. RESULTS:Twenty-four seizures were reported (.08/1000 sessions). TMS delivered within published guidelines to subjects without recognized risk factors caused 4 seizures (<.02/1000 sessions). High-frequency (>1?Hz) rTMS delivered within published guidelines to individuals without known risk factors was no more likely to cause seizures than low-frequency and single/paired-pulse TMS. Subject risk factors (e.g., brain lesions and epilepsy) increased seizure risk substantially. Seizures appeared more common when safety guidelines were exceeded. Seizures were most likely to occur within the first few exposures to TMS. CONCLUSIONS:TMS delivered within published guidelines to individuals without risk factors appears to cause fewer than 1 seizure per 60,000 sessions. The assumption that repetitive TMS is riskier than single and paired pulses under these conditions should be reevaluated. SIGNIFICANCE:This information should help laboratories, clinics, and regulatory authorities form updated safety policies for TMS.

SUBMITTER: Lerner AJ

PROVIDER: S-EPMC7274462 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Seizures from transcranial magnetic stimulation 2012-2016: Results of a survey of active laboratories and clinics.

Lerner Adam J AJ Wassermann Eric M EM Tamir Diana I DI

Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology 20190406 8

<h4>Objective</h4>Transcranial magnetic stimulation (TMS) can cause seizures in healthy individuals and patients. However, the rate at which this occurs is unknown. We estimated the risk of seizure and other adverse events with TMS.<h4>Methods</h4>We surveyed laboratories and clinics about seizures and other events observed between 2012 and 2016 (inclusive). Respondents (N = 174) reported an estimated 318,560 TMS sessions.<h4>Results</h4>Twenty-four seizures were reported (.08/1000 sessions). TM ...[more]

PMID: 31104898

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Project description:When considering repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder, clinicians often face a lack of detailed information on potential interactions between rTMS and pharmacotherapy. This is particularly relevant to patients receiving bupropion, a commonly prescribed antidepressant with lower risk of sexual side effects or weight increase, which has been associated with increased risk of seizure in particular populations. Our aim was to systematically review the information on seizures occurred with rTMS to identify the potential risk factors with attention to concurrent medications, particularly bupropion.We conducted a systematic review through the databases PubMed, PsycINFO, and EMBASE between 1980 and June 2015. Additional articles were found using reference lists of relevant articles. Reporting of data follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Two reviewers independently screened articles reporting the occurrence of seizures during rTMS. Articles reporting seizures in epilepsy during rTMS were excluded. A total of 25 rTMS-induced seizures were included in the final review.Data were systematically extracted, and the authors of the applicable studies were contacted when appropriate to provide more detail about the seizure incidents.Twenty-five seizures were identified. Potential risk factors emerged such as sleep deprivation, polypharmacy, and neurological insult. High-frequency-rTMS was involved in a percentage of the seizures. None of these seizures reported had patients taking bupropion in the literature review. One rTMS-induced seizure was reported from the Food and Drug Administration in a sleep-deprived patient who was concurrently taking bupropion, sertraline, and amphetamine.During the consent process, potential risk factors for an rTMS-induced seizure should be carefully screened for and discussed. Data do not support considering concurrent bupropion treatment as contraindication to undergo rTMS.

Dataset Information

Seizures from transcranial magnetic stimulation 2012-2016: Results of a survey of active laboratories and clinics.

Publications

Seizures from transcranial magnetic stimulation 2012-2016: Results of a survey of active laboratories and clinics.

Similar Datasets

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