Adverse effects in repetitive transcranial magnetic stimulation – prevention and management

Abstract

Introduction

Repetitive Transcranial Magnetic Stimulation (rTMS), through modulation of cortical activity, has become an invaluable tool in experimental and clinical neurosciences. Although this form of noninvasive treatment is considered safer than other means of brain stimulation it has been associated with adverse effects (AE).

Objective

To make a brief review, concerning the AE of rTMS, their prevention and management.

Aims

To understand and be able to deal with the most common AE associated with rTMS.

Methods

A PubMed database search, using as keywords “Transcranial magnetic stimulation”, “Repetitive Transcranial magnetic stimulation”; “adverse effects”; “management” and “guidelines” between the year 1998 and 2015.

Results

AE caused by rTMS are rare. They can be classified into severe (seizures) and mild (syncope, and transient hearing impairment, acute psychiatric changes, headache, local pain, neck pain, toothache, paresthesia and cognitive/neuropsychological changes) and into early and late AE. In order to obviate and avoid them, guidelines have been created; some state that to apply rTMS the technician needs to obtain the patient's informed consent and assess the risks/benefit ratio. To meet these criteria, screening tools have been created, and since then the number of AE has reduced.

Conclusions

Even though rTMS is considered safer than other forms of brain stimulation it is still associated with AE. In order to avoid them, screening tools have been created allowing the clinician to assess the risks and benefits of applying this technique.

Disclosure of interest

The authors have not supplied their declaration of competing interest.