Europe PMC

This website requires cookies, and the limited processing of your personal data in order to function. By using the site you are agreeing to this as outlined in our privacy notice and cookie policy.

Abstract 


Induction of a seizure in a normal subject with trains of repetitive transcranial magnetic stimulation (rTMS) applied in close succession suggested that short inter-train intervals, a parameter not considered in our previous safety studies, may not be safe. Here, we evaluate the safety of different inter-train intervals for rTMS in 10 healthy volunteers. Ten rTMS trains at 20 Hz for 1.6 s and a stimulus intensity of 110% of motor threshold (MT) were found to be safe at the inter-train interval of 5 s. However, inter-train intervals of 1 s or less were unsafe for trains of 20 Hz for 1.6 s and stimulus intensities higher than 100% of MT. Based on these results, we propose safety guidelines for inter-train intervals at different stimulus intensities. We also analyzed the stimulus parameters, used in 3 studies, that led to seizures in normal subjects. One seizure was due to short inter-train intervals, one was likely related to intense individual rTMS trains close to the limit of our previous safety recommendations, and one was likely due to a combination of these two factors. To provide an additional safety margin, we suggest reducing the duration for individual rTMS trains by 25% from our previous recommendations. Updated safety tables currently in use at our institution are provided.

References 


Articles referenced by this article (26)

  • Chen, R., Classen, J., Gerloff, C., Celnik, P., Wassermann, E.M., Hallett, M. and Cohen, L.G. Depression of motor cortex excitability by low frequency transcranial magnetic stimulation. Neurology, 1997a, 48: 1398–1403.

  • Chen, R., Gerloff, C., Hallett, M. and Cohen, L.G. Involvement of the ipsilateral motor cortex in finger movements of different complexities. Ann. Neurol., 1997b, 41: 247–254.

  • Cohen, L.G., Roth, B.J., Nilsson, J., Dang, N., Panizza, M., Bandinelli, S., Friauf, W. and Hallett, M. Effect of coil design on delivery of focal magnetic stimulation. Technical considerations. Electroencephalogr. clin. Neurophysiol., 1990, 75: 350–357.

  • George, M.S., Wassermann, E.M., Williams, W.A., Callahan, A., Ketter, T.A., Basser, P., Hallett, M. and Post, R.M. Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression. NeuroReport, 1995, 6: 1853–1856.

  • George, M.S., Wassermann, E.M., Williams, W.A., Steppel, J., Pascual-Leone, A., Basser, P., Hallett, M. and Post, R.M. Changes in mood and hormone levels after rapid-rate transcranial magnetic stimulation (rTMS) of the prefrontal cortex. J. Neuropsychiatry Clin. Neurosci., 1996, 8: 172–180.

  • Grafman, J., Pascual-Leone, A., Alway, D., Nichelli, P., Gomez-Tortosa, E. and Hallett, M. Induction of a recall deficit by rapid-rate transcranial magnetic stimulation. NeuroReport, 1994, 5: 1157–1160.

  • Graham Brown, T. Studies in the physiology of the nervous system XXII: On the phenomenon of facilitation. Its occurrence in reactions induced by stimulation of the `motor' cortex of the cerebrum in monkeys. Q. J. Exp. Physiol., 1915a, 9: 81–99.

  • Graham Brown, T. Studies in the physiology of the nervous system XXIV: On the phenomenon of facilitation. 2: Its occurrence in response to subliminal cortical stimuli in monkeys. Q. J. Exp. Physiol., 1915b, 9: 101–116.

  • Malenka, R.C. Postsynaptic factors control the duration of synaptic enhancement in area CA1 of the hippocampus. Neuron, 1991, 6: 53–60.

  • Miles, R. and Wong, R.K.S. Latent synaptic pathways revealed after tetanic stimulation in the hippocampus. Nature, 1987, 329: 724–726.

Show 10 more references (10 of 26)

Citations & impact 


Impact metrics

Jump to Citations

Citations of article over time

Alternative metrics

Altmetric item for https://www.altmetric.com/details/41558402
Altmetric
Discover the attention surrounding your research
https://www.altmetric.com/details/41558402

Article citations


Go to all (123) article citations