From the Guidelines
Transcranial Magnetic Stimulation (TMS) treatment is generally safe, but patients should be aware of potential side effects, including seizures, skin irritation, and increased risk in specific patient subgroups, such as those with a history of substance use or certain medical implants. The safety of TMS has been extensively reviewed, and guidelines are largely based on minimizing the risk of seizures 1. Common side effects of TMS include headache, scalp discomfort, and facial muscle twitching, which are typically mild to moderate and diminish after the first few sessions. More serious but rare side effects, such as seizures, can occur, especially in patients with factors that increase the risk of seizures, like cocaine use, alcohol withdrawal, or benzodiazepine use/withdrawal 1.
Key Considerations
- Patients with metal implants, history of seizures, or those taking medications that lower seizure threshold should exercise caution or avoid TMS altogether
- Pregnant women should discuss the risks with their doctor, as TMS hasn't been extensively studied during pregnancy
- Patients with certain medical devices, such as cochlear implants or pacemakers, should avoid TMS due to potential interference
- Skin irritation can occur with transcranial electrical stimulation (tES), especially if standard protocols are not followed 1
Precautions and Safety Monitoring
- Patients should provide a complete medical history and medication list to their provider before starting TMS
- Safety monitoring measures, such as urinary samples or blood alcohol levels, may be necessary to identify potential substance use or other risk factors
- TMS safety guidelines should be carefully respected when delivering treatment to younger populations, such as teenagers or children, with addiction 1
From the Research
Potential Side Effects of TMS
- Headache or local pain at the site of stimulation 2
- Seizures, although rare, with a risk of <1% overall 3
- Hearing impairment or mania, which are uncommon 2
- Dizziness and tinnitus, as reported in some studies 4
- Sleep deprivation and alcohol use may increase the risk of seizures 3
Precautions for TMS Treatment
- Special consideration is required for certain populations, including adolescents, pregnant women, older adults, and those with metal/electronic implants 2
- Patients with a history of traumatic brain injury, epilepsy, or prior TMS-related seizure require careful assessment and monitoring 3, 2
- The use of TMS in patients with drug-resistant epilepsy has shown promising results, but the evidence for efficacy is still limited 4
- TMS can be safely administered in a large proportion of depressed patients with adequate assessment and monitoring processes 2
Safety Guidelines for TMS Use
- The risk of seizures is low, even in patients taking drugs acting on the central nervous system, with the use of traditional stimulation parameters and focal coils 5
- New issues discussed in detail include safety issues of recently developed stimulation devices and pulse configurations, and novel scenarios of TMS applications 5
- Updates on the possible induction of seizures and minimal training requirements for operators are provided 5
- A summary of the minimal training requirements for operators and a note on ethics of neuroenhancement are also included 5