Seizure Induced by Deep Transcranial Magnetic Stimulation in an Adolescent with Depression
- 1 September 2016
- journal article
- case report
- Published by Mary Ann Liebert Inc in Journal of Child and Adolescent Psychopharmacology
- Vol. 26 (7), 637-641
- https://doi.org/10.1089/cap.2016.0070
Abstract
Objective: Deep transcranial magnetic stimulation (TMS) with an H-1 coil was recently approved by the U.S. Food and Drug Administration (U.S. FDA) for treatment-resistant depression (TRD) in adults. Studies assessing the safety and effectiveness of deep TMS in adolescent TRD are lacking. The purpose of this brief report is to provide a case history of an adolescent enrolled in an investigational deep TMS protocol. Methods: A case history is described of the first participant of a sham-controlled clinical trial who had a seizure in the course of deep TMS with parameter settings extrapolated from the adult studies that led to US FDA approval (H-1 coil, 120% target stimulation intensity, 18 Hz, 55 trains of 2-second duration, total 1980 pulses). Results: The participant was a 17-year-old unmedicated female, with no significant medical history and no history of seizures or of drug or alcohol use. Brain magnetic resonance imaging showed no structural abnormalities. She initially received sham, which was well tolerated. During active treatment sessions, titration began at 85% of motor threshold (MT) and increased by 5% per day. Her weekly MT measurements were stable. On her first day of 120% MT (8th active treatment), during the 48th train, the participant had a generalized, tonic–clonic seizure that lasted 90 seconds and resolved spontaneously. She had an emergency medicine evaluation and was discharged home without anticonvulsant medications. There were no further seizures reported at a 6-month follow-up. Conclusions: We report a deep TMS-induced generalized tonic–clonic seizure in an adolescent with TRD participating in a clinical trial. Given the demonstrated benefits of deep TMS for adult TRD, research investigating its use in adolescents with TRD is an important area. However, in light of this experience, additional precautions for adolescents should be considered. We propose that further dose-finding investigations are needed to refine adolescent-specific parameters that may be safe and effective for treating adolescents with TRD with deep TMS.Keywords
This publication has 29 references indexed in Scilit:
- Repetitive Transcranial Magnetic Stimulation Induced Seizures in an Adolescent Patient with Major Depression: A Case ReportBrain Stimulation, 2013
- TRANSCRANIAL MAGNETIC STIMULATION (TMS) FOR MAJOR DEPRESSION: A MULTISITE, NATURALISTIC, OBSERVATIONAL STUDY OF ACUTE TREATMENT OUTCOMES IN CLINICAL PRACTICEDepression and Anxiety, 2012
- Electric field depth–focality tradeoff in transcranial magnetic stimulation: Simulation comparison of 50 coil designsBrain Stimulation, 2012
- Adjunctive Use of Repetitive Transcranial Magnetic Stimulation in Depressed AdolescentsThe Journal of Clinical Psychiatry, 2011
- Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and researchClinical Neurophysiology, 2009
- Deep transcranial magnetic stimulation over the prefrontal cortex: Evaluation of antidepressant and cognitive effects in depressive patientsBrain Stimulation, 2009
- Switching to Another SSRI or to Venlafaxine With or Without Cognitive Behavioral Therapy for Adolescents With SSRI-Resistant DepressionJAMA, 2008
- Transcranial Magnetic Stimulation in Child Neurology: Current and Future DirectionsJournal of Child Neurology, 2007
- Three-Dimensional Distribution of the Electric Field Induced in the Brain by Transcranial Magnetic Stimulation Using Figure-8 and Deep H-CoilsJournal Of Clinical Neurophysiology, 2007
- rTMS reduces focal brain hyperperfusion in two patients with EPCActa Neurologica Scandinavica, 2004