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Seizure Risk Associated With the Use of Transcranial Magnetic Stimulation for Coma Recovery in Individuals With
David Ripley1, Kelly Krese, Joshua M Rosenow
1Author Affiliations: HealthBridge Complex Care (Dr Ripley), Arlington Heights, Illinois; Shirley Ryan AbilityLab Brain Innovation Center (Drs Ripley, Krese, Roth, and Kestner), Chicago, Illinois; The Department of Veterans Affairs (VA), Research Service (Drs Krese, Kletzel, Livengood, Aaronson, Herrold, Blabas, Guernon, Kestner, Walsh, and Pape), Department of Neurology (Dr Patil), The Department of Veterans Affairs Mental Health Service Line (Drs Pacheco and Aaronson), Cooperative Studies Program Coordinating Center (Dr D. Bhaumik), Edward Hines Jr. VA Hospital, Hines, Illinois; Department of Neurological Surgery & Neurology (Drs Rosenow and Schuele), Department of Physical Medicine and Rehabilitation (Drs Schuele, Roth, Livengood, Rosenow and Pape), Department of Psychiatry and Behavioral Sciences (Dr Herrold), Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Neurology, Stritch School of Medicine (Dr Patil), Loyola University, Chicago, Illinois; Department of Psychiatry (Dr Aaronson), Department of Psychiatry, Biostatistical Research Center, Division of Epidemiology and Biostatistics (Drs R. Bhaumik and D. Bhaumik), University of Illinois at Chicago, Chicago, Illinois; and Department of Speech-Language Pathology (Dr Guernon), Lewis University, Romeoville, Illinois.
Repetitive transcranial magnetic stimulation (rTMS) shows low seizure risk for disorder of consciousness (DoC) after traumatic brain injury (TBI). Ventriculoperitoneal shunts may increase risk, warranting prophylactic measures.
Area of Science:
- Neuroscience
- Neurology
- Rehabilitation Medicine
Background:
- Repetitive transcranial magnetic stimulation (rTMS) is a novel therapy for disorder of consciousness (DoC) post-traumatic brain injury (TBI).
- Clinical application of rTMS is limited by concerns regarding potential exacerbation of seizure risk in vulnerable individuals.
Purpose of the Study:
- To investigate the seizure risk associated with rTMS in patients with DoC following TBI.
- To provide evidence-based insights into the safety profile of rTMS for DoC-TBI patients.
Main Methods:
- A meta-analysis of three clinical trials involving 20 participants with DoC after TBI.
- Participants received either active or placebo rTMS targeting the dorsolateral prefrontal cortex.
- Seizure occurrences were compared between active and placebo groups using logistic regression and chi-square tests.
Main Results:
- A low incidence rate of 59 seizures per 1000 persons was observed.
- No significant difference in seizure occurrence was found between active and placebo rTMS groups.
- The presence of a ventriculoperitoneal shunt was associated with an elevated seizure risk (RR=2.0).
Conclusions:
- The studied rTMS protocol appears to have a low likelihood of increasing baseline seizure rates in DoC-TBI patients.
- Individuals with DoC-TBI and ventriculoperitoneal shunts may face an elevated seizure risk with rTMS.
- Pharmacological seizure prophylaxis should be considered for patients with VP shunts undergoing rTMS.
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