Capability of navigated repeated transcranial magnetic stimulation in stroke rehabilitation (Randomized blind sham-controlled study) (Clinicaltrials.gov identifier: NCT01652677)

Risk of seizures in transcranial magnetic stimulation: a clinical review to inform consent process focused on bupropion

“…Briefly, 19 cases had HF-rTMS (>3 Hz), 23 – 34 , 42 four cases with multiple single-pulse stimulations, 23 , 35 – 38 , 42 one continuous theta-burst stimulation (cTBS), 39 and one not reported. 40 Fifteen reports were cases where motor cortex was stimulated, 23 , 28 , 29 , 32 , 35 – 39 , 41 , 42 nine where prefrontal cortex was stimulated, 24 – 27 , 30 , 31 , 33 , 34 and one not reported. 40 The intensity of stimulation used is very heterogeneous and ranges from 40% to 130% resting motor threshold (RMT).…”

“…Reports were heterogeneous when reporting potential risk factors for seizures, but most identified at least one potential risk factor that could contribute to increasing the probability of inducing a seizure during rTMS treatment. These risk factors include neurological insult or preexisting condition, including multiple sclerosis, stroke, and traumatic brain injury, 28 , 29 , 32 , 36 – 38 , 40 , 42 interrupted sleep pattern, 31 , 35 , 39 and a history of seizures. 33 , 41 The six remaining case reports did not contain enough information to determine if risk factors were present.…”

“…Therefore, 21 articles that reported 25 rTMS-induced seizures were included in the final literature review. 23 – 42 Two raters conducted the search and went through the selection process and reviewed the full-text papers. Another investigator independently rated the 43 full-text articles selected to confirm that the final articles were properly selected based on the criteria.…”

“…Additional information extracted pertained to the paper by Kandler, dictated that the stimulation would have been using a large coil placed at the vertex to stimulate the small hand and foot muscles, and that the frequency of the stimuli would have been no more than 0.3 Hz (–RH Kandler, Department of Clinical Neurophysiology, Royal Hallamshire Hospital, electronic communication, February 6, 2014). Chervyakov et al 42 also described the two seizures reporting their stroke location (left and right middle cerebral artery basin), the rTMS session that the seizures occurred (single pulse during diagnostic mapping, 1 st session of high frequency rTMS), also that both seizures were associated with underestimation of the EEG data during screening (A Chervyakov, electronic communication, June 15, 2015, Research center of neurology, Russian Academy of Medical Science, Moscow, Russia).…”