TY - JOUR
T1 - Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research
AU - Rossi, Simone
AU - Hallett, Mark
AU - Rossini, Paolo M.
AU - Pascual-Leone, Alvaro
AU - Avanzini, Giuliano
AU - Bestmann, Sven
AU - Berardelli, Alfredo
AU - Brewer, Carmen
AU - Canli, Turhan
AU - Cantello, Roberto
AU - Chen, Robert
AU - Classen, Joseph
AU - Demitrack, Mark
AU - Di Lazzaro, Vincenzo
AU - Epstein, Charles M.
AU - George, Mark S.
AU - Fregni, Felipe
AU - Ilmoniemi, Risto
AU - Jalinous, Reza
AU - Karp, Barbara
AU - Lefaucheur, Jean Pascal
AU - Lisanby, Sarah
AU - Meunier, Sabine
AU - Miniussi, Carlo
AU - Miranda, Pedro
AU - Padberg, Frank
AU - Paulus, Walter
AU - Peterchev, Angel
AU - Porteri, Corinna
AU - Provost, Miriam
AU - Quartarone, Angelo
AU - Rotenberg, Alexander
AU - Rothwell, John
AU - Ruohonen, Jarmo
AU - Siebner, Hartwig
AU - Thut, Gregor
AU - Valls-Solè, Josep
AU - Walsh, Vincent
AU - Ugawa, Yoshikatzu
AU - Zangen, Abraham
AU - Ziemann, Ulf
N1 - Funding Information:
The workshop was supported by the International Federation of Clinical Neurophysiology (IFCN), the European Chapter of the IFCN, the National Institute of Neurological Disorders and Stroke, the University of Siena, as well as unrestricted gifts from Magstim, Nexstim, and Neuronetics. APL was also supported by the Berenson-Allen Family Foundation.
PY - 2009/12/1
Y1 - 2009/12/1
N2 - This article is based on a consensus conference, which took place in Certosa di Pontignano, Siena (Italy) on March 7-9, 2008, intended to update the previous safety guidelines for the application of transcranial magnetic stimulation (TMS) in research and clinical settings. Over the past decade the scientific and medical community has had the opportunity to evaluate the safety record of research studies and clinical applications of TMS and repetitive TMS (rTMS). In these years the number of applications of conventional TMS has grown impressively, new paradigms of stimulation have been developed (e.g., patterned repetitive TMS) and technical advances have led to new device designs and to the real-time integration of TMS with electroencephalography (EEG), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI). Thousands of healthy subjects and patients with various neurological and psychiatric diseases have undergone TMS allowing a better assessment of relative risks. The occurrence of seizures (i.e., the most serious TMS-related acute adverse effect) has been extremely rare, with most of the few new cases receiving rTMS exceeding previous guidelines, often in patients under treatment with drugs which potentially lower the seizure threshold. The present updated guidelines review issues of risk and safety of conventional TMS protocols, address the undesired effects and risks of emerging TMS interventions, the applications of TMS in patients with implanted electrodes in the central nervous system, and safety aspects of TMS in neuroimaging environments. We cover recommended limits of stimulation parameters and other important precautions, monitoring of subjects, expertise of the rTMS team, and ethical issues. While all the recommendations here are expert based, they utilize published data to the extent possible.
AB - This article is based on a consensus conference, which took place in Certosa di Pontignano, Siena (Italy) on March 7-9, 2008, intended to update the previous safety guidelines for the application of transcranial magnetic stimulation (TMS) in research and clinical settings. Over the past decade the scientific and medical community has had the opportunity to evaluate the safety record of research studies and clinical applications of TMS and repetitive TMS (rTMS). In these years the number of applications of conventional TMS has grown impressively, new paradigms of stimulation have been developed (e.g., patterned repetitive TMS) and technical advances have led to new device designs and to the real-time integration of TMS with electroencephalography (EEG), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI). Thousands of healthy subjects and patients with various neurological and psychiatric diseases have undergone TMS allowing a better assessment of relative risks. The occurrence of seizures (i.e., the most serious TMS-related acute adverse effect) has been extremely rare, with most of the few new cases receiving rTMS exceeding previous guidelines, often in patients under treatment with drugs which potentially lower the seizure threshold. The present updated guidelines review issues of risk and safety of conventional TMS protocols, address the undesired effects and risks of emerging TMS interventions, the applications of TMS in patients with implanted electrodes in the central nervous system, and safety aspects of TMS in neuroimaging environments. We cover recommended limits of stimulation parameters and other important precautions, monitoring of subjects, expertise of the rTMS team, and ethical issues. While all the recommendations here are expert based, they utilize published data to the extent possible.
KW - Safety
KW - TMS
KW - Transcranial magnetic stimulation
KW - rTMS
UR - http://www.scopus.com/inward/record.url?scp=70450273261&partnerID=8YFLogxK
U2 - 10.1016/j.clinph.2009.08.016
DO - 10.1016/j.clinph.2009.08.016
M3 - Review article
C2 - 19833552
AN - SCOPUS:70450273261
SN - 1388-2457
VL - 120
SP - 2008
EP - 2039
JO - Clinical Neurophysiology
JF - Clinical Neurophysiology
IS - 12
ER -