Transcranial Magnetic Stimulation: Clinical Applications for Psychiatric Practice; Second Edition by Unknown

Author:Unknown
Language: eng
Format: epub
Tags: Subjects: MESH: Transcranial Magnetic Stimulation | Depressive Disorder, Major--therapy
Publisher: American Psychiatric Association Publishing
Published: 2024-05-15T00:00:00+00:00

Safety and Tolerability of TMS for OCD

Several studies and meta-analyses established the safety of TMS for OCD (Carmi et al. 2019; Liang et al. 2021; Roth et al. 2021). The tolerability of TMS treatment appeared to be similar to that of sham TMS across multiple studies that used different coil designs, multiple targets, and stimulation protocols (Liang et al. 2021). In the pivotal H7 coil study (Carmi et al. 2019), active and sham treatments were equally tolerable, with approximately 30% of the participants reporting adverse events (AEs) in both groups (P = 0.64, χ2 test). The most frequent AE reported by both groups was a headache, and the difference between the groups was not statistically significant. One patient in the active treatment group reported suicidal ideation and was hospitalized after the second treatment. The subject later indicated that the onset of the suicidal ideation started before the study and was related to family problems rather than TMS. Dropout rates were approximately 12% in both groups, with no statistical differences. In the postmarketing study (Roth et al. 2021), application site 151

discomfort and headaches were the most common AEs reported. Several investigations using H coils with a design similar to the H7 coil in patients with various mental health conditions (e.g., PTSD and major depressive disorder) reported similar tolerability rates (Rossi et al. 2021).

The risk for seizure with TMS is less than 1%. This risk depends on the design and shape of the coil, stimulation protocol, positioning on the scalp, and patient-specific characteristics that predispose them to seizure in the absence of TMS. Double-cone coils such as H coils and the DB80 coil are designed to induce an electrical field penetrating deeper and broader with less focality in the brain than standard figure-eight coils (e.g., Neuronetics iron core). Theoretically, this design implies an increased risk for seizures. Mikellides et al. (2021) reported a seizure when using the FDA-cleared protocol and a DB80 coil in a 19-year-old patient with OCD. This patient had a previous course of TMS for depression with a figure-eight coil and focal neurological lesions found on MRI. During a subsequent course of TMS for OCD with the DB80 coil placed 4 cm anterior to the motor cortex, the patient had one seizure during TMS and another after the course ended. The seizure could be due to TMS, the underlying neurological condition, or both (i.e., multifactorial). Regarding H coils, the manufacturer reported on 48,252 patients treated predominantly with the H1 coil presumably positioned over the left DLPFC (Tendler et al. 2018; Zibman et al. 2021). Forty-six patients experienced seizures, corresponding to a seizure per patient frequency of 85/100,000, or 4/100,000 sessions (i.e., in less than 1% of patients).

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