rTMS-Associated Adverse Events, Safety and Monitoring

Abstract

Repetitive transcranial magnetic stimulation is generally considered a safe and well-tolerated interventional tool. However, there are a number of significant contraindications to rTMS stimulation and safety considerations. The major contraindications to rTMS treatment are (1) conditions that substantially predispose an individual to seizure induction, such as history of epilepsy, an active brain illness or significant alcohol or drug withdrawal, and (2) the presence of programmable devices (such as a pacemaker) or implanted metallic material in the brain that is likely to be adversely affected by strong magnetic fields. The major adverse event concern with rTMS is seizure induction. The likelihood of seizure induction appears to be very low with standard methods of stimulation, and this can be limited by careful patient selection and by closely adhering to established safety guidelines. rTMS stimulation also can induce a syncopal episode, especially in more vulnerable individuals. Fortunately, rTMS does not appear to induce cognitive impairment, and there is no evidence of adverse impacts of rTMS stimulation on brain tissue. Hearing protection should be worn during rTMS treatment by patients and treatment providers. Greater care should be taken with the provision of rTMS treatment in special populations such as children or pregnant women.