Background:Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation intervention used to treat mental illness 1 ; it has been approved by the UK National Institute of Clinical Excellence as safe and clinically effective 2 . This study aimed to investigate the incidence of side effects (SE) of rTMS in patients receiving low and high-frequency treatment. Methods: 115 participants were selected from a patient-data system. Ages ranged from 18-85. Patients were treated across 7 clinics in the UK and Ireland. All patients had a diagnosis of depression with anxiety or OCD from a registered clinician. Patients had at least five rTMS sessions [Depression: F4 cTBS 40 seconds 80% rMT and F3 or Fz 10hz 20 minutes 3200 pulses 120% rMT] [OCD: F4 cTBS 40 seconds 80% rMT and FCz 1hz 20 minutes 100% rMT 1200 pulses or just FP1 intermittent 1hz 19 minutes 720 pulses]. An opportunistic retrospective chart review was conducted on 115 patient logs. An initial qualitative content analysis was used to assimilate all noted side effects into 12 concise categories. Percent averages of incidence were calculated for the low-frequency sub-group (23 patients), high-frequency sub-group (92 patients) and overall (115 patients), for each SE. Multiple Pearson's Chi-Squared tests calculated if the differences between the two groups were significant. Results:Overall the three most prevalent SE were headache (20%), fatigue (16.5%) and scalp discomfort (6.0%). Every other SE had between 0.8%-3.5% prevalence. Every SE was more prevalent in the high Hz group compared to the low Hz group except nausea, light-headed, and tooth-pain. Conclusions:The intergroup differences were not statistically significant. Statistical significance was not found because the low-frequency group had a low sample size. This highlights the need for further SE research and data on rTMS patients.
Background:Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation intervention used to treat mental illness 1 ; it has been approved by the UK National Institute of Clinical Excellence as safe and clinically effective 2 . This study aimed to investigate the incidence of side effects (SE) of rTMS in patients receiving low and high-frequency treatment. Methods: 115 participants were selected from a patient-data system. Ages ranged from 18-85. Patients were treated across 7 clinics in the UK and Ireland. All patients had a diagnosis of depression with anxiety or OCD from a registered clinician. Patients had at least five rTMS sessions [Depression: F4 cTBS 40 seconds 80% rMT and F3 or Fz 10hz 20 minutes 3200 pulses 120% rMT] [OCD: F4 cTBS 40 seconds 80% rMT and FCz 1hz 20 minutes 100% rMT 1200 pulses or just FP1 intermittent 1hz 19 minutes 720 pulses]. An opportunistic retrospective chart review was conducted on 115 patient logs. An initial qualitative content analysis was used to assimilate all noted side effects into 12 concise categories. Percent averages of incidence were calculated for the low-frequency sub-group (23 patients), high-frequency sub-group (92 patients) and overall (115 patients), for each SE. Multiple Pearson's Chi-Squared tests calculated if the differences between the two groups were significant. Results:Overall the three most prevalent SE were headache (20%), fatigue (16.5%) and scalp discomfort (6.0%). Every other SE had between 0.8%-3.5% prevalence. Every SE was more prevalent in the high Hz group compared to the low Hz group except nausea, light-headed, and tooth-pain. Conclusions:The intergroup differences were not statistically significant. Statistical significance was not found because the low-frequency group had a low sample size. This highlights the need for further SE research and data on rTMS patients.
Background: Annually, 20% of US adults will suffer chronic pain(CP) for more than six months, 8% to a degree that limits their life and work activities. CP results from a combination of biological, psychological and social factors and requires a multifactorial approach to manage. The evaluation and management of CP syndromes follows the biopsychosocial approach, attempting to identify the cause and type of pain syndrome. Treatment begins with patient education, which includes setting patient expectations and initiating non-pharmacological interventions. The 2019 guidelines for the therapeutic use of rTMS scored high-frequency motor cortex(MC) stimulation to the contralateral MC for neuropathic pain as level A, for fibromyalgia level B, and for CRPS I level C. Several small Deep TMS studies demonstrate the analgesic effect of somatotopic MC stimulation. Here, we report on real world utilization of Deep-TMS for CP, to aid in patient expectations. Methods: The database of a psychiatry clinic was reviewed for patients who received deep-TMS for CP syndromes. The stimulation parameters were 20 Hz, 2.5 sec train, 20 sec inter-train interval, 30 trains, 1500 total pulses, at 100% of motor threshold of area in pain, treated over that area on MC. The primary endpoint was the change in the comparative pain scale(CPS) from baseline to endpoint. Results: Thirteen patients with a variety of CPS were treated, including two with CRPS. Eleven improved at endpoint. First treatment analgesia (-1.8±0.4, p¼0.0005) was predictive of treatment success (r¼0.59, p¼0.003), and further decreased at endpoint (-3.3±0.7, p¼0.0003). CPS reduction was independent of psychiatric comorbidity response. Conclusions: Somatotopic MC Deep-TMS offers meaningful non-pharmacologic analgesia to CPS and CRPS patients. Controlled dosing and maintenance studies are warranted. Funding: None. Disclosures: Aron Tendler has a financial interest in BrainsWay as well as a commercial/research TMS center. Tal Harmelech is an employee of BrainsWay.
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