Risk of seizures in transcranial magnetic stimulation: a clinical review to inform consent process focused on bupropion

Abstract

ObjectiveWhen considering repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder, clinicians often face a lack of detailed information on potential interactions between rTMS and pharmacotherapy. This is particularly relevant to patients receiving bupropion, a commonly prescribed antidepressant with lower risk of sexual side effects or weight increase, which has been associated with increased risk of seizure in particular populations. Our aim was to systematically review the information on seizures occurred with rTMS to identify the potential risk factors with attention to concurrent medications, particularly bupropion.Data sourcesWe conducted a systematic review through the databases PubMed, PsycINFO, and EMBASE between 1980 and June 2015. Additional articles were found using reference lists of relevant articles. Reporting of data follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Study selectionTwo reviewers independently screened articles reporting the occurrence of seizures during rTMS. Articles reporting seizures in epilepsy during rTMS were excluded. A total of 25 rTMS-induced seizures were included in the final review.Data extractionData were systematically extracted, and the authors of the applicable studies were contacted when appropriate to provide more detail about the seizure incidents.ResultsTwenty-five seizures were identified. Potential risk factors emerged such as sleep deprivation, polypharmacy, and neurological insult. High-frequency-rTMS was involved in a percentage of the seizures. None of these seizures reported had patients taking bupropion in the literature review. One rTMS-induced seizure was reported from the Food and Drug Administration in a sleep-deprived patient who was concurrently taking bupropion, sertraline, and amphetamine.ConclusionDuring the consent process, potential risk factors for an rTMS-induced seizure should be carefully screened for and discussed. Data do not support considering concurrent bupropion treatment as contraindication to undergo rTMS.

Recent Advances in Non-invasive Brain Stimulation for Major Depressive Disorder

“…The most common side effects of rTMS in clinical settings include headache (5%–23%) and discomfort at the stimulus site (20%–40%), and the most severe side effect is the induction of seizures (Machii et al, 2006 ; Maizey et al, 2013 ; Wall et al, 2014 ; Dobek et al, 2015 ; Boes et al, 2016 ). Prikryl and Kucerova ( 2005 ) reported a case of generalized tonic clonic seizure in a patient with MDD receiving rTMS.…”

“…To date, fewer than 25 cases of rTMS-induced seizure have been reported worldwide. Therefore, high frequency rTMS is contraindicated in patients with a history of seizures, although the incidence rate is relatively low (<0.1%; Dobek et al, 2015 ).…”

Low-Frequency Repetitive Transcranial Magnetic Stimulation Ameliorates Cognitive Function and Synaptic Plasticity in APP23/PS45 Mouse Model of Alzheimer’s Disease

“…Most of these researches have focused on the effects of high-frequency rTMS on cognitive function in AD. However, high-frequency rTMS may occasionally cause some side effects, such as headache and epilepsy or epileptic seizures (Wassermann, 1998 ; Dobek et al, 2015 ), whereas no such risk has been reported for low-frequency rTMS to date. Although accumulating evidence have shown that low-frequency rTMS can improve cognitive functions in patients with mood disorders, psychotic disorders, cerebrovascular accident and so on (Lage et al, 2016 ), it is still under debate whether low-frequency rTMS has beneficial effects on cognitive function in AD patients.…”

H-Coil Repetitive Transcranial Magnetic Stimulation Induced Seizure in an Adult with Major Depression: A Case Report

“…To our knowledge, this is the third reported case of an induced seizure using an H-coil, with one occurring in a patient undergoing treatment for depression and the other in a patient being treated for bipolar disorder [1,9]. A recent review found 9 total rTMS-induced seizures associated with depression treatment reported in the literature, and 25 rTMS-induced seizures overall [10]. The addition of an adverse event report by Brainsway [1] and the current case brings the total to 11 rTMS-induced seizures occurring in patients undergoing treatment for depression, with two from an H-coil.…”