Transcranial Magnetic Stimulation (TMS) Safety with Respect to Seizures: A Literature Review

Figures & data

Table 1 Stultz et al TMS Seizure Review Articles

	Reference	Coil Type	Description
Introduction	Lefaucheur et al 2020^Citation1	Multiple	Review on the use of TMS for multiple disorders using various coil types such as Figure 8, Circular, Double Cone, Hesed
	McClintock et al 2018^Citation2	H1, Figure 8	TMS approved for depression in 2008
	Chung et al 2015^Citation3	Multiple	Review of the application of theta burst TMS using multiple coil types such as Double Cone, Figure 8, H-coil
	Sonmez et al 2019^Citation4	Not Specified	Review on the use of accelerated TMS protocol
TMS and Coils	Rossi et al 2009^Citation5	N/A	General seizure risk with TMS <0.003%
	Oberman et al 2011^Citation6	N/A	Seizure risk with theta burst rTMS is around 0.02%
	Carpenter et al 2012^Citation7	Figure 8	Seizure risk <1% with TMS
	Janicak et al 2020^Citation8	Figure 8	Neurostar seizure rates lower than initially reported
	Tendler et al 2018^Citation9	H1	Reviewed 31 seizure cases, rate of 0.087%.
	Cavinato et al 2012^Citation10	Figure 8	31 y/o male, Hx of severe TBI, had a partial and secondarily generalized tonic-clonic seizure on 4th of 10 daily sessions
	Koudijis et al 2010^Citation11	Round, Fig. 8	34 children aged 5 mo. to 19 y/o with intractable epilepsy underwent TMS, temporary increase in seizures in 4 children
	Lerner et al 2019^Citation12	Multiple	Risk of seizures with TMS is 0.08/1000 for Figure 8, 0.12/1000 for Double Cone, 0.43 for H-coil.
TMS Seizure Risk Factors	Rossi et al 2009^Citation5	N/A	Higher frequencies and short intervals between trains can increase risk; See description under TMS & Coils
	Wasserman 1998^Citation13	N/A	<20 second intervals between series leads to increased seizure risk
	McClintock et al 2018^Citation2	H1, Figure 8	Tonic-clonic seizure during TMS due to direct stimulation of motor cortex or adjacent brain areas; Also cited in Intro
	George & Belmaker 2007^Citation14	N/A	Several factors related to increased seizure risk
Differential Diagnosis	Sheldon et al 2002^Citation15	N/A	Distinctions between syncope and seizures
	Kinback 2018^Citation16	H1	42 y/o female, Tx 21 had partial tonic seizure
Theta Burst TMS	Oberman & Pascual-Leone 2009^Citation17	Figure 8	33 y/o male, possibly sleep deprived, seizure during final train of session
	Purushotham et al 2018^Citation18	Figure 8	15 y/o female, Hx of schizophrenia, Tx 1 had seizure
	Lenoir et al 2018^Citation19	Double Cone	2 cases of seizures (One generalized, one partial complex)
	Allen et al 2017^Citation20	N/A	Reviewed 3 TBS studies involving healthy children and pediatric patients with CNS Disorders, no reported seizures.
Accelerated TMS	Kallel & Brunelin 2020^Citation21	Figure 8	18 y/o female, had seizure that was first localized then generalized during 3rd session of 2nd day
TMS and Psychotropics	Rossi et al 2009^Citation5	N/A	Some meds/substances can potentially increase seizure risk; See description under TMS & Coils and Risk Factors
	Loo et al 2008^Citation22	N/A	If medications are adjusted during TMS, re-check motor threshold
	Dobek et al 2015^Citation23	N/A	TMS-induced seizures and antidepressant use; Bupropion is not a contraindication
	Lertxurdi et al 2013^Citation24	N/A	2nd gen antipsychotics may have a higher risk of seizures, especially clozapine
	Khoury & Ghossoub 2019^Citation25	N/A	0.5–1.2% risk of seizures with antipsychotics, clozapine increases risk the most
	Thanki et al 2020^Citation26	Figure 8	60 y/o male, Hx of hyponatremic seizures, completed TMS safely twice (once on sertraline, another time on venlafaxine)
TMS in Children/Adolescents	Allen et al 2017^Citation20	N/A	Reviewed 23 rTMS studies involving children w/CNS disorders & epilepsy, 3 seizures in CNS. See Theta Burst TMS
	Hu et al 2011^Citation27	Figure 8	15 y/o female, on sertraline, generalized tonic-clonic seizure during Tx 1, became hypomanic from TMS
	Chiramberro et al 2013^Citation28	Figure 8	16 y/o female, Tx 12 had seizure, later found high level of blood alcohol concentration
	Cullen et al 2016^Citation29	H1	17 y/o female, Tx 8 had generalized tonic-clonic seizure
	Purushotham et al 2018^Citation18	Figure 8	See description under Theta Burst TMS
	Wang et al 2018^Citation30	Figure 8	16 y/o female, Hx of migraines w/auras, Tx 1 had generalized tonic-clonic seizure
	Muir et al 2019^Citation31	H1	Reviewed 6 pts., 1 case of seizure in pt. w/Hx of autism, multiple head injuries, and D/C of oxcarbazepine prior to TMS
	Zewdie et al 2019^Citation32	Fig. 8, D.Cone	Reviewed 384 children who underwent TMS, no seizures occurred
TMS and Bipolar Disorder	Tharayil et al 2005^Citation33	Not Specified	35 y/o pt. with family Hx of seizures had generalized seizure while on lithium and chlorpromazine.
	Sakkas et al 2007^Citation34	Figure 8	30 y/o female, Type I Bipolar Disorder, manic, stopped diazepam on her own prior to Tx 9, had Jacksonian seizure
	Harel et all 2011^Citation35	H1	1 patient out of 19 had a generalized seizure
	Iliceto et al 2018^Citation36	Figure 8	37 y/o male, Type I Bipolar Disorder, Hx of TBI, completed TMS safely
TMS and TBI	Dhaliwal et al 2015^Citation37	Fig. 8, Focal	Severe TBI increases seizure risk
	Reti et al 2015^Citation38	N/A	TBI increases seizure risk, low frequency rTMS may be better option for those with a Hx
	Bernabeu et al 2004^Citation39	Circular	28 y/o female with Hx of TBI on fluoxetine, had secondarily generalized tonic-clonic seizure using fast rTMS protocol
	Cavinato et al 2012^Citation10	Figure 8	See description under TMS & Coils
	Pape et al 2014^Citation40	Not Specified	2 pts. w/Hx of TBI underwent TMS. Pt. #1 completed safely, Pt. #2 had an EEG seizure w/no clinical S/S at Tx 21
	Boes et al 2016^Citation41	H1	27 y/o male had generalized tonic-clonic seizure at Tx 12, Hx of alcohol use and 4 head injuries
	Muir et al 2019^Citation31	H1	See description under TMS in Children/Adolescents
TMS and Head Injuries w/o Seizures	Fitzgerald et al 2011^Citation42	Figure 8	41 y/o female with Hx of mild TBI, completed 20 Txs
	Kreuzer et al 2013^Citation43	Figure 8	53 y/o male had severe tinnitus after TBI, completed 5 Tx series over 3 years
	Neville et al 2015^Citation44	Figure 8	Double-blind study involving 36 pts. aged 18–60 y/o with Hx of TBI
	Nielson et al 2015^Citation45	Figure 8	48 y/o male with Hx of severe TBI, finished 30 Txs; 90% lower risk of seizure if none w/in 2 years of injury
	Englander et al 2003^Citation47	N/A	CT scan results and neurosurgical procedures useful in determining risk for late posttraumatic seizures
	Koski et al 2015^Citation48	Figure 8	Treated 12 pts. aged 20–60 y/o, 60% male, 60% had ≥3 concussions
	Rutherford et al 2017^Citation49	Not Specified	13 pts. with mild TBI, 7 real TMS + 6 sham; rTMS may be effective for some symptoms of post-concussion syndrome
	Paxman et al 2018^Citation50	Not Specified	61 y/o male had chronic dizziness after a mild TBI, completed 10 Txs
	Lee & Kim 2018^Citation51	Figure 8	13 pts. aged 19–60 y/o with Hx of TBI, received 10 sessions of real or sham TMS
	Iliceto et al 2018^Citation36	Figure 8	See description under TMS and Bipolar Disorder
	Saunders & Bermudes 2018^Citation53	Figure 8	55 y/o female had TBI unrelated to TMS after 10 sessions, resumed TMS 11 days later, 4 different protocols used
	Siddiqi et al 2018^Citation54	Not Specified	Studied effects of resting-state fMRI-targeted rTMS in a retired NFL player, Hx of repetitive head trauma.
	Stultz et al 2019^Citation55	H1	23 y/o male with Hx of 4 concussions
TMS and Alcohol Use	Tendler et al 2018^Citation9	H1	6/31 pts. reviewed who had a seizure involved increased alcohol intake
	Boes et al 2016^Citation41	H1	See description under TMS and TBI
	Chiramberro et al 2013^Citation28	Figure 8	See description under TMS in Children/Adolescents
TMS and Sleep Deprivation	Nakken et al 2005^Citation56	N/A	Reported on 1677 pts. with epilepsy, those with generalized seizures report to be more sensitive to sleep deprivation
	Ferlisi & Shorvon 2014^Citation57	N/A	Pts. with idiopathic generalized epilepsy more sensitive to seizures while sleep deprived
	Prikryl & Kucerova 2005^Citation58	Not Specified	45 y/o male who was sleep deprived for 2 nights had a grand mal seizure during Tx 6
	Tendler et al 2018^Citation9	H1	3/31 pts. reviewed who had a seizure c/o sleep deprivation
	Oberman & Pascual-Leone 2009^Citation17	Figure 8	See description under Theta Burst TMS
TMS and Epilepsy	Bae et al 2007^Citation59	N/A	Risk of seizures in pts. with epilepsy <2%
	Pereira et al 2016^Citation60	N/A	Reviewed 410 epilepsy pts. receiving TMS, 12 of which had a seizure, suggesting a seizure risk of 2.9%
	Vernet et al 2012^Citation61	Not Specified	22 y/o male, drug-resistant symptomatic focal epilepsy, had seizure clinically similar to typical spontaneous seizures
	Allen et al 2017^Citation20	N/A	Reviewed 23 rTMS studies involving children with CNS disorders & epilepsy, no seizures reported in epileptic pts.
	Koudijis et al 2010^Citation11	Round, Fig. 8	See description under TMS and Coils
	Stultz et al 2019^Citation62	H1	69 y/o female, Hx of complex partial seizures, completed TMS without having a seizure
	Fitzgerald 2014^Citation63	Not Specified	57 y/o male, tried ECT in the past, had not experienced seizures for 11 years, completed TMS safely at low-frequency
Continued TMS After a Seizure	Bagati et al 2012^Citation64	Not Specified	44 y/o male, had seizure during Tx 4, continued TMS after being prescribed valproate
	Stultz et al 2019^Citation65	H1	48 y/o female, developed tonic clonic seizure during Tx 11, continued TMS after evaluation with no reported seizures
	Kallel & Brunelin 2020^Citation21	Figure 8	See description under Accelerated TMS. Continued with TMS after decreasing to 1 session per day.
Treatment Plan	Fitzgerald & Daskalakis 2012^Citation66	N/A	rTMS-related seizures likely to terminate quickly and not require additional treatment

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