Can Transcranial Magnetic Stimulation (TMS) treatment cause Electrolyte Imbalance and Convulsion/Seizure?

Seizures and Electrolyte Imbalances Following TMS Treatment

Seizures are a rare but recognized potential adverse effect of Transcranial Magnetic Stimulation (TMS) treatment, while electrolyte imbalances are not directly associated with TMS therapy.

Risk of Seizures with TMS

• TMS safety guidelines are primarily focused on minimizing the risk of seizures, which remains the most serious potential acute adverse effect of TMS treatment 1
• The overall risk of TMS-related seizures is extremely low, estimated at less than 1% 2
• Seizures can occur even with single-pulse TMS in individuals without predisposing factors, though this is exceptionally rare 3
• When seizures do occur during TMS treatment, they are typically self-limiting and do not require extensive intervention 2

Factors That May Increase Seizure Risk During TMS

• Certain medications that lower seizure threshold can theoretically increase brain sensitivity to TMS-induced seizures 1
• Specific substances that may increase seizure risk include:
  • Cocaine use
  • Alcohol withdrawal
  • Benzodiazepine/barbiturate use/withdrawal in opioid users
  • Tramadol use
  • Bupropion in nicotine treatment 1, 4
• Pre-existing conditions that may increase risk include:
  • History of epilepsy
  • Recent stroke
  • Head trauma
  • Skull defects or craniotomy sites 4

Electrolyte Imbalances and TMS

• There is no evidence in the provided literature suggesting that TMS directly causes electrolyte imbalances 1
• The guidelines for TMS safety do not mention electrolyte disturbances as a known adverse effect 1, 4
• Unlike Electroconvulsive Therapy (ECT), which can cause more significant physiological changes, TMS is generally considered to have fewer systemic effects 1

Comparing TMS with ECT

• ECT is associated with more significant physiological effects than TMS, including potential for prolonged seizures and tardive seizures 1
• ECT requires close monitoring for seizure activity, with patients typically monitored for 24 hours for potential tardive seizures 1
• ECT has documented side effects including headache, nausea, vomiting, muscle aches, confusion, and agitation 1
• In contrast, TMS has a more favorable safety profile with fewer systemic effects 1

Safety Monitoring for TMS

• Standard safety protocols for TMS include:
  • Comprehensive screening for contraindications before initiating treatment 4
  • Assessment of medication profiles for drugs that may lower seizure threshold 4
  • Evaluation of recent substance use that could increase adverse event risk 1
• For patients with addiction disorders or other high-risk conditions, additional safety monitoring measures may be warranted 1

Conclusion on the Adverse Event Report

• The reported association between TMS and seizures is plausible based on existing literature, though rare 2, 5
• The reported association between TMS and electrolyte imbalance is not supported by the available evidence and guidelines 1
• If a patient experiences a seizure during TMS treatment, a thorough evaluation should be conducted to identify potential contributing factors 4, 2