Safety of rapid-rate transcranial magnetic stimulation: heart rate and blood pressure changes

We examined the influence of rapid-rate transcranial magnetic stimulation on heart rate and blood pressure in 13 healthy volunteers. In a first series three different cortical magnetic stimuli were applied: over C3, C4 and Fz (10/20 system), in a second series additionally over Pz. We also used a stimulus over the brachial plexus and a sham stimulus. Five stimuli of each location were applied with a Cadwell high speed magnetic stimulator using a focal point circular coil. Stimulus train duration was 500 ms, stimulus frequency 20 Hz. Stimulus strength was 70-90% of maximum stimulator output, 20% of maximum stimulator output above subjects' individual motor threshold. The subjects assessed stimulus inconvenience immediately after stimulation. ECG and blood pressure (Finapres) were recorded continuously during the 1 h test. In all subjects there was a clearly marked autonomic response with heart rate acceleration and decrease in blood pressure after all stimuli. There was no difference in responses between cortical stimuli. Blood pressure decrease after sham stimulation was significantly smaller than after cortical stimulation, it was more marked after brachial plexus stimulation. Autonomic reaction correlates well with subjective estimation of stimulus inconvenience. We conclude the observed effect of rapid-rate transcranial magnetic stimulation to be associated to rather an unspecific arousal reaction than to a direct stimulation of autonomic cortex areas. We did not observe any clinically relevant side-effects.