Safety and tolerability of repeated sessions of deep transcranial magnetic stimulation in obesity

Abstract

Purpose Repetitive Transcranial Magnetic Stimulation (rTMS) has been demonstrated to be effective in body weight control in individuals with obesity. Most clinical trials on rTMS provided a reassuring safety profile. In the present work, we present an extensive analysis on both severe and mild Adverse Events (AEs) in obese individuals treated with rTMS. Methods We examined the intensity, duration, correlation with the treatment, up to 1 year after the end of rTMS treatment. Results Descriptive analysis included a total of 63 subjects undergoing a 5-week deep rTMS experimental treatment for obesity (age 48.3 ± 10.4 years; BMI 36.3 ± 4.4 kg/m2): 31 patients were treated with high-frequency rTMS (HF), 13 with low-frequency rTMS (LF), and 19 were sham treated (Sham). Thirty-two subjects (50.8%) reported a total of 52 AEs, including mainly moderate (51.9%) events. The most frequently reported side effects were headaches of moderate intensity (40.4%) and local pain/discomfort (19.2%) and resulted significantly more frequent in HF group compared to other groups (p < 0.05). No significant differences among groups were found for the other reported AEs: drowsiness, insomnia, paresthesia, vasovagal reactions, hypertensive crisis. No AEs potentially related to the rTMS arised up to 1 year from the end of the treatment. Conclusions This is the first comprehensive safety analysis in obese patients treated with rTMS. The analysis did not reveal any unexpected safety concerns. Only headaches and local pain/discomfort have been significantly more frequent in the HF group, confirming the good tolerability of rTMS even in the obese population potentially more susceptible to side effects of brain stimulation.

Transcranial magnetic stimulation-based closed-loop modality for activity of daily living gain in spinal cord injury: a retrospective study using propensity score matching analysis

“…Although the incidence of side effects in TBCL group was slightly higher than in SR group, improvements in monitoring skills and post-treatment care are inclined to lower discomfort. 25 , 26 Some studies even report on the near-zero incidence of rTMS-relevant side effects. 27 , 28 On the other hand, as an additional approach, rTMS inevitably added to rehabilitative consumption and incidence of side effects.…”

Non-invasive transcranial ultrasound stimulation for neuromodulation

“…A limitation of this report, however, was that other non-invasive brain stimulation and acquisition techniques such as TMS, EEG, EMG, and MRI were used during these experiments (Legon et al, 2020). Given that shortterm and nonspecific symptoms such as anxiety and noise-induced headache have been reported in both neuroimaging (Cosottini et al, 2014) and transcranial magnetic stimulation (Ferrulli et al, 2021) experiments, definite attribution of these symptoms to TUS was not possible.…”

Deep transcranial magnetic stimulation in combination with skin thermography in obesity: a window on sympathetic nervous system

“…It includes repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and a variant of TMS [i.e., deep transcranial magnetic stimulation (dTMS)], able to stimulate deeper brain regions as the insula. Recently, we demonstrated the safety and efficacy of dTMS, targeted to the prefrontal cortex (PFC) and insula bilaterally, in controlling food craving and reducing body weight, up to 1-year period in individuals with obesity [ 17 , 18 ], through enhancing inhibitory capacity of PFC overeating behavior [ 19 ], and modulating intra-cerebral dopamine release. The potential for NBS to become an effective and safe strategy for the management of obesity has been confirmed by other randomized clinical trials [ 20 ].…”