Safety of repetitive transcranial magnetic stimulation in patients with epilepsy: A systematic review.




Curated By TMS Solutions on Jan 18, 2017 8:35:00 PM
Curated By TMS Solutions
Title:
Safety of repetitive transcranial magnetic stimulation in patients with epilepsy: A systematic review.
Authors:
Pereira LS; Muller VT; da Mota Gomes M; Rotenberg A; Fregni F.
Institution Pereira, Luisa Santos. Spaulding Neuromodulation Center, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02129, USA. Muller, Vanessa Teixeira. Institute of Neurology Deolindo Couto, Federal University of Rio de Janeiro, RJ 22290-140, Brazil. da Mota Gomes, Marleide. Institute of Neurology Deolindo Couto, Federal University of Rio de Janeiro, RJ 22290-140, Brazil. Rotenberg, Alexander. Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA. Fregni, Felipe. Spaulding Neuromodulation Center, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02129, USA. Electronic address:
 
Title:
Safety of repetitive transcranial magnetic stimulation in patients with epilepsy: A systematic review. 
 
Source:
Epilepsy & Behavior. 57(Pt A):167-76, 2016 Apr.
 
Abstract:
Approximately one-third of patients with epilepsy remain with
pharmacologically intractable seizures. An emerging therapeutic modalitfor seizure suppression is repetitive transcranial magnetic stimulation (rTMS). Despite being considered a safe technique, rTMS carries the risk of inducing seizures, among other milder adverse events, and thus, its safety in the population with epilepsy should be continuously assessed. We performed an updated systematic review on the safety and tolerability of rTMS in patients with epilepsy, similar to a previous report published in 2007 (Bae EH, Schrader LM, Machii K, Alonso-Alonso M, Riviello JJ,
Pascual-Leone A, Rotenberg A. Safety and tolerability of repetitive transcranial magnetic stimulation in patients with epilepsy: a review of the literature. Epilepsy Behav. 2007; 10 (4): 521-8), and estimated the risk of seizures and other adverse events during or shortly after rTMS application. We searched the literature for reports of rTMS being applied on patients with epilepsy, with no time or language restrictions, and obtained studies published from January 1990 to August 2015. A total of 46 publications were identified, of which 16 were new studies published after the previous safety review of 2007. We noted the total number of subjects with epilepsy undergoing rTMS, medication usage, incidence of adverse events, and rTMS protocol parameters: frequency, intensity, total numberof stimuli, train duration, intertrain intervals, coil type, and stimulation site. Our main data analysis included separate calculations  for crude per subject risk of seizure and other adverse events, as well as risk per 1000 stimuli. We also performed an exploratory, secondary analysis on the risk of seizure and other adverse events according to the type of coil used (figure-of-8 or circular), stimulation frequency (< 1 Hz or > 1 Hz), pulse intensity in terms of motor threshold (<100% or > 100%), and number of stimuli per session (< 500 or > 500). Presence or absence of adverse events was reported in 40 studies (n = 426 subjects). A total of 78 (18.3%) subjects reported adverse events, of which 85% were mild. Headache or dizziness was the most common one, occurring in 8.9%. We found a crude per subject seizure risk of 2.9% (95% CI: 1.3-4.5), given that 12 subjects reported seizures out of 410 subjects included in the analysis after data of patients with epilepsia partialis continua or status epilepticus were excluded from the estimate. Only one of the reported seizures was considered atypical in terms of the clinical characteristics of the patients' baseline seizures. The atypical seizure happened during high-frequency rTMS with maximum stimulator output for speech arrest, clinically arising from the region of stimulation. Although we estimated a larger crude per subject seizure risk compared with the previous safety review, the corresponding confidence intervals contained both risks. Furthermore, the exclusive case of atypical seizure was the same as reported in the previous report. We conclude that the risk of seizure induction in patients with epilepsy undergoing rTMS is small and that the risk of other adverse events is similar to that of rTMS applied to other conditions and to healthy subjects.
 
Conclusion:
Our results should be interpreted with caution, given the need for adjusted analysis controlling for potential confounders, such as baseline seizure frequency. The similarity between the safety profiles of rTMS applied to the population with epilepsy and to individuals without epilepsy supports further investigation of rTMS as a therapy for seizure suppression.
 
Copyright:
2016. Published by Elsevier Inc.
 
Publication Type:
Journal Article. Review.

Topic of this Article:

Topics: Epilepsy, rTMS


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