Monitoring an electroencephalogram for the safe application of therapeutic repetitive transcranial magnetic stimulation

Kanno, Manabu

doi:10.1136/jnnp.71.4.559

Cited by 8 publications

(5 citation statements)

References 7 publications

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“…There is one observation of potentially epileptiform activity online to TMS over central leads in a patient that raises concern (Kanno et al, 2001). This is because the transient epileptiform activity occurred during rTMS at very low frequency (0.25 Hz) and early into the train (4th stimulus) so that it could not be assigned to cumulative pulse effects and seemed to be driven by only a few single pulses.…”

Section: Side Effectsmentioning

confidence: 99%

“…This is because the transient epileptiform activity occurred during rTMS at very low frequency (0.25 Hz) and early into the train (4th stimulus) so that it could not be assigned to cumulative pulse effects and seemed to be driven by only a few single pulses. In addition, this activity was likely to be TMS-induced, because it was reproduced during a second TMS session on another day (Kanno et al, 2001). Because this patient suffered from uncontrolled movements of trunk and limb, it is plausible that this patient's motor cortex might have been extremely hyperexcitable as compared to other populations (Kanno et al, 2001).…”

Section: Side Effectsmentioning

confidence: 99%

“…In addition, this activity was likely to be TMS-induced, because it was reproduced during a second TMS session on another day (Kanno et al, 2001). Because this patient suffered from uncontrolled movements of trunk and limb, it is plausible that this patient's motor cortex might have been extremely hyperexcitable as compared to other populations (Kanno et al, 2001). Aside from this observation, however, there is no report of epileptiform activity in the many publications ( n > 25) that recorded EEG online to single-pulse TMS with a methodological or fundamental neuroscientific perspective (Bridgers and Delaney, 1989; Kujirai et al, 1993; Nikouline et al, 1999; Tiitinen et al, 1999; Paus et al, 2001; Schürmann et al, 2001; Kähkönen et al, 2001, 2004, 2005; Komssi et al, 2002, 2004; Kübler et al, 2002; Thut et al, 2003a,b; Thut et al, 2005; Massimini et al, 2005, 2007; Price, 2004; Fuggetta et al, 2005, 2006; Bonato et al, 2006; Van Der Werf et al, 2006; Van Der Werf and Paus, 2006; Morbidi et al, 2007; Litvak et al, 2007; Julkunen et al, 2008; Romei et al, 2008a,b).…”

Section: Side Effectsmentioning

confidence: 99%

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Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research

Rossi

Hallett

Rossini

et al. 2009

Clinical Neurophysiology

4,467

3,435

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This article is based on a consensus conference, which took place in Certosa di Pontignano, Siena (Italy) on March 7–9, 2008, intended to update the previous safety guidelines for the application of transcranial magnetic stimulation (TMS) in research and clinical settings. Over the past decade the scientific and medical community has had the opportunity to evaluate the safety record of research studies and clinical applications of TMS and repetitive TMS (rTMS). In these years the number of applications of conventional TMS has grown impressively, new paradigms of stimulation have been developed (e.g., patterned repetitive TMS) and technical advances have led to new device designs and to the real-time integration of TMS with electroencephalography (EEG), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI). Thousands of healthy subjects and patients with various neurological and psychiatric diseases have undergone TMS allowing a better assessment of relative risks. The occurrence of seizures (i.e., the most serious TMS-related acute adverse effect) has been extremely rare, with most of the few new cases receiving rTMS exceeding previous guidelines, often in patients under treatment with drugs which potentially lower the seizure threshold. The present updated guidelines review issues of risk and safety of conventional TMS protocols, address the undesired effects and risks of emerging TMS interventions, the applications of TMS in patients with implanted electrodes in the central nervous system, and safety aspects of TMS in neuroimaging environments. We cover recommended limits of stimulation parameters and other important precautions, monitoring of subjects, expertise of the rTMS team, and ethical issues. While all the recommendations here are expert based, they utilize published data to the extent possible.

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Section: Side Effectsmentioning

confidence: 99%

Section: Side Effectsmentioning

confidence: 99%

Section: Side Effectsmentioning

confidence: 99%

See 1 more Smart Citation

Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research

Rossi

Hallett

Rossini

et al. 2009

Clinical Neurophysiology

4,467

3,435

View full text Add to dashboard Cite

show abstract

“…Real-time EEG monitoring might allow immediate discontinuation of an rTMS trial in the event that EEG abnormalities are induced by TMS. 93 In addition, the ability to assess the immediate impact of TMS on epileptic discharges provides new possibilities for epilepsy research that go beyond the use of EEG to document the long-term effects of rTMS treatment. 88,90,92,94,95 More information on the mechanisms through which rTMS interferes with the generation of epileptic activity is undoubtedly needed to further develop rTMS into an effective, alternative, treatment strategy for pharmacoresistant epilepsy.…”

Section: Outstanding Questionsmentioning

confidence: 99%

Technology Insight: noninvasive brain stimulation in neurology—perspectives on the therapeutic potential of rTMS and tDCS

2007

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In neurology, as in all branches of medicine, symptoms of disease and the resulting burden of illness and disability are not simply the consequence of the injury, inflammation or dysfunction of a given organ; they also reflect the consequences of the nervous system's attempt to adapt to the insult. This plastic response includes compensatory changes that prove adaptive for the individual, as well as changes that contribute to functional disability and are, therefore, maladaptive. In this context, brain stimulation techniques tailored to modulate individual plastic changes associated with neurological diseases might enhance clinical benefits and minimize adverse effects. In this Review, we discuss the use of two noninvasive brain stimulation techniques--repetitive transcranial magnetic stimulation and transcranial direct current stimulation--to modulate activity in the targeted cortex or in a dysfunctional network, to restore an adaptive equilibrium in a disrupted network for best behavioral outcome, and to suppress plastic changes for functional advantage. We review randomized controlled studies, in focal epilepsy, Parkinson's disease, recovery from stroke, and chronic pain, to illustrate these principles, and we present evidence for the clinical effects of these two techniques.

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“…TMS is used to cause muscle contraction by trans-synaptic stimulation of the pyramidal tract (2,3). Treatment with trains of repetitive TMS (rTMS) can change the cortical function (4,5) and is thought to have therapeutic effects such as antidepressive effects (6,7). Acute application of rTMS to the dorsolateral prefrontal cortex (PFC) induces reductions in anxiety associated with a contralateral increase in theta activity (8).…”

Section: Introductionmentioning

confidence: 99%

Effects of Acute Repetitive Transcranial Magnetic Stimulation on Extracellular Serotonin Concentration in the Rat Prefrontal Cortex

et al. 2003

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Abstract. Repetitive transcranial magnetic stimulation (rTMS) changes the function of the cortex. This study clarified the effects of acute rTMS treatment on extracellular serotonin (5-HT) concentrations in the rat prefrontal cortex (PFC) by using in vivo microdialysis methods. Each rat received acute rTMS treatment of the frontal brain at 500 stimuli from twenty trains applied at 25 Hz for 1 s at 1-min intervals between trains. Sham-treated rats received the same handling procedure and sound of the stimulator. Sham treatment increased the extracellular 5-HT levels compared with the non-treated group. However, rTMS treatment using the stimulation intensity of 110% motor threshold eliminated the increase in 5-HT levels induced by the sham treatment. Acute rTMS treatment of the frontal brain is related to the serotonergic neuronal system in the rat PFC, and it may have therapeutic implications for emotional disorders.

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Monitoring an electroencephalogram for the safe application of therapeutic repetitive transcranial magnetic stimulation

Cited by 8 publications

References 7 publications

Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research

Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research

Technology Insight: noninvasive brain stimulation in neurology—perspectives on the therapeutic potential of rTMS and tDCS

Effects of Acute Repetitive Transcranial Magnetic Stimulation on Extracellular Serotonin Concentration in the Rat Prefrontal Cortex

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