Repetitive Transcranial Magnetic Stimulation-Induced Seizure of a Patient with Adolescent-Onset Depression: A Case Report and Literature Review

Sh, Hu; Ss, Wang; Mm, Zhang; Wang, Jiwen; Jb, Hu; Ml, Huang; N, Wei; Wh, Zhou; Hl, Qi; Wang, Xu; Xu, You

doi:10.1177/147323001103900552

Cited by 44 publications

(33 citation statements)

References 26 publications

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“…She did not have further seizures. Authors noted that the concurrent use of sertraline may have reduced the seizure threshold in this patient (Hu et al 2011). Chiamberro et al (2013) reported on a 16-year-old girl with depression (concurrently treated with sertraline, olanzapine, and hydroxyzine, also with limited benefit) who was initiated in a repetitive TMS treatment protocol using the figure-8 coil over the dorsolateral prefrontal cortex, at 10 Hz, with 60 trains of 5-second duration, 25-second intertrain interval, and 3000 stimuli per day, 5 days a week.…”

Section: Discussionmentioning

confidence: 79%

“…Hu et al (2011) reported on a 15-year-old female with depression (concurrently taking sertraline with limited benefit) who was initiated on a repetitive TMS protocol with the figure-8 coil over the left dorsolateral prefrontal cortex at 100% of resting MT, 10 Hz, 60 trains of 5-second duration, 25-second intertrain interval, and 3000 total pulses. During the first treatment, she had a generalized, tonic-clonic seizure.…”

Section: Discussionmentioning

confidence: 99%

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Seizure Induced by Deep Transcranial Magnetic Stimulation in an Adolescent with Depression

Cullen

Jasberg

Nelson

et al. 2016

Journal of Child and Adolescent Psychopharmacology

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Objective: Deep transcranial magnetic stimulation (TMS) with an H-1 coil was recently approved by the U.S. Food and Drug Administration (U.S. FDA) for treatment-resistant depression (TRD) in adults. Studies assessing the safety and effectiveness of deep TMS in adolescent TRD are lacking. The purpose of this brief report is to provide a case history of an adolescent enrolled in an investigational deep TMS protocol. Methods: A case history is described of the first participant of a sham-controlled clinical trial who had a seizure in the course of deep TMS with parameter settings extrapolated from the adult studies that led to US FDA approval (H-1 coil, 120% target stimulation intensity, 18 Hz, 55 trains of 2-second duration, total 1980 pulses). Results: The participant was a 17-year-old unmedicated female, with no significant medical history and no history of seizures or of drug or alcohol use. Brain magnetic resonance imaging showed no structural abnormalities. She initially received sham, which was well tolerated. During active treatment sessions, titration began at 85% of motor threshold (MT) and increased by 5% per day. Her weekly MT measurements were stable. On her first day of 120% MT (8th active treatment), during the 48th train, the participant had a generalized, tonic-clonic seizure that lasted 90 seconds and resolved spontaneously. She had an emergency medicine evaluation and was discharged home without anticonvulsant medications. There were no further seizures reported at a 6-month follow-up. Conclusions: We report a deep TMS-induced generalized tonic-clonic seizure in an adolescent with TRD participating in a clinical trial. Given the demonstrated benefits of deep TMS for adult TRD, research investigating its use in adolescents with TRD is an important area. However, in light of this experience, additional precautions for adolescents should be considered. We propose that further dose-finding investigations are needed to refine adolescent-specific parameters that may be safe and effective for treating adolescents with TRD with deep TMS.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Seizure Induced by Deep Transcranial Magnetic Stimulation in an Adolescent with Depression

Cullen

Jasberg

Nelson

et al. 2016

Journal of Child and Adolescent Psychopharmacology

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“…Of these, eight published manuscripts were case reports [44, 64–70]. Three publications, one on tDCS [23] and two on TMS [66, 71], did not report the adverse effects of NIBS modalities, nor was the information available from the corresponding authors or ClinicalTrials.gov.…”

Section: Resultsmentioning

confidence: 99%

“…rTMS was the most frequently examined NIBS modality, with 35 publications addressing the application of TMS on children and adolescents (3.0 to 17.8 years old) [38–40, 44–46, 52, 55–57, 64–67, 70, 71, 73, 75–81, 83, 85–94]. The duration of the interventions ranged from one day to 18 weeks, and the stimulation provided was administered in frequencies ranging from 0.3Hz to 10Hz; two studies reported priming the subject with a frequency of 6Hz before the procedure [46, 52].…”

Section: Resultsmentioning

confidence: 99%

Safety of Noninvasive Brain Stimulation in Children and Adolescents

et al. 2015

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Background Noninvasive brain stimulation (NIBS) techniques such as transcranial magnetic stimulation (TMS) and transcranial current stimulation (tCS) have the potential to mitigate a variety of symptoms associated with neurological and psychiatric conditions, including stroke, cerebral palsy, autism, depression, and Tourette syndrome. While the safety of these modalities has been established in adults, there is a paucity of research assessing the safety of NIBS among children. Objective To examine the existing literature regarding the safety of NIBS techniques in children and adolescents with neurologic and neuropsychiatric disorders. Methods An electronic search was performed on online databases for studies using NIBS in individuals less than 18 years of age. Non-English publications, diagnostic studies, electroconvulsive therapy, single/dual pulse TMS studies, and reviews were excluded. Adverse events reported in the studies were carefully examined and synthesized to understand the safety and tolerability of NIBS among children and adolescents. Results The data from 48 studies involving more than 513 children/adolescents (2.5–17.8 years of age) indicate that the side-effects of NIBS were, in general, mild and transient [TMS: headache (11.5%), scalp discomfort (2.5%), twitching (1.2%), mood changes (1.2%), fatigue (0.9%), tinnitus (0.6%); tCS: tingling (11.5%), itching (5.8%), redness (4.7%), scalp discomfort (3.1%)] with relatively few serious adverse events. Conclusion Our findings indicate that both repetitive TMS and tCS are safe modalities in children and adolescents with various neurological conditions, especially when safety guidelines are followed. The incidence of adverse events appears to be similar to that observed in adults; however, further studies with longer treatment and follow-up periods are needed to better understand the benefits and tolerance of long-term use of NIBS in children.

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“…49 Transcranial magnetic stimulation is another potential treatment for resistant depression but there have been a few case reports of seizures. 30,50 More studies are required to assess the effectiveness and safety of these techniques for treating depression in individuals with epilepsy.…”

Section: Management Of Depression In Epilepsymentioning

confidence: 99%

What do we know about depression in people with epilepsy?

Muzerengi¹,

Moor²

2013

Prog Neurol Psychiatry

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Depression is the commonest comorbid psychiatric condition in epilepsy. 1 The relationship between epilepsy and depression was described as far back as 400 BC by Hippocrates. 2 Studies have consistently shown a higher prevalence rate of depression in patients with epilepsy compared with the general population. 3 In a Canadian population-based study, authors reported an estimated lifetime prevalence of mood disorders of 24.4 per cent in individuals with epilepsy, compared to 13.2 per cent in those without. The lifetime prevalence of major depression was 17.4 per cent in those with epilepsy compared to 10.7 per cent in people without epilepsy. 3 Other psychiatric disorders including anxiety, bipolar disorder and suicidal ideation were also more common in the epilepsy group. Higher prevalence rates of up to 48 per cent have been reported in tertiary centre-based studies. 3 These patients were more likely to have refractory epilepsy and temporal lobe epilepsy and hence have an increased risk of comorbid psychiatric disorders. 3,4 Despite its high prevalence in epilepsy, depression remains poorly recognised and undertreated by health professionals. 5 In a study to assess the effect of sertraline on seizure frequency in 100 patients with epilepsy and depression, 60 per cent had a one-year history of psychiatric symptoms, but only 35 per cent of these had been offered or requested treatment within six months of symptom onset. 5 Gilliam et al. found that in the majority of patients, depression is missed because clinicians do not enquire about depressive symptoms. 6 The impact of depression needs to be highlighted. Depression and low mood have been shown to be a strong predictor of health-related quality of life. [6][7][8] Even in people with well controlled seizures, depression remains the main determinant of quality of life. 9 A higher suicide rate has also been reported in people with epilepsy compared with their healthy counterparts. Lifetime prevalence of suicidal ideation in individuals with epilepsy was 25 per cent and 13.3 per cent in healthy controls. 3 Furthermore, the presence of psychiatric illness, and more so depression, has been shown to be associated with poor response to antiepileptic treatment. 10 Hitiris et al. followed up 780 patients with new-onset epilepsy over a median period of 79 months. Patients with epilepsy and psychiatric illnesses were less likely to be seizure free than those with epilepsy without depression. 10 Similar results were found in individuals undergoing epilepsy surgery for temporal lobe epilepsy. Those who had a history of depression were less likely to be seizure or aura free compared with those with epilepsy and no psychiatric history. 11,12 These findings highlight the need for increased awareness of this common psychiatric symptom among clinicians .In this article, we discuss the risk factors, pathophysiology and treatment strategies for depression in epilepsy. What are the risk factors for depression in epilepsy?Several factors including gender, genetics, seizure type, ep...

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Repetitive Transcranial Magnetic Stimulation-Induced Seizure of a Patient with Adolescent-Onset Depression: A Case Report and Literature Review

Cited by 44 publications

References 26 publications

Seizure Induced by Deep Transcranial Magnetic Stimulation in an Adolescent with Depression

Seizure Induced by Deep Transcranial Magnetic Stimulation in an Adolescent with Depression

Safety of Noninvasive Brain Stimulation in Children and Adolescents

What do we know about depression in people with epilepsy?

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