TMS Treatment for Patients with Seizure Disorders
Dr. Danish and the team at Philadelphia Integrative Psychiatry are excited to announce the availability of Transcranial Magnetic Stimulation (TMS) for the treatment of depression, anxiety, obsessive-compulsive disorder (OCD), addiction, attention-deficit/hyperactivity disorder (ADHD), and other mental health disorders. For many adults suffering from depression, this innovative treatment is covered by insurance, marking a significant step forward in accessible mental health care. This blog delves into the groundbreaking aspect of TMS treatment, particularly its application in patients with seizure disorders, as highlighted in a recent case report published in the Brain Stimulation journal.
The Case Report Overview
The case report under discussion presents a 35-year-old female with a history of severe treatment-resistant depression, a resected brainstem glioma, and a partial seizure disorder who underwent high-frequency repetitive transcranial magnetic stimulation (rTMS). This patient's journey through depression and seizure management using rTMS, specifically intermittent theta burst stimulation (iTBS), sheds light on the potential of TMS to safely and effectively treat patients with complex medical histories.
Treatment and Results
Treatment Approach and Protocol:
The patient was treated with iTBS, a form of rTMS, using a Brainsway TMS with an H1 coil. The treatment consisted of 35 sessions, with a specific focus on safety and tolerability, especially given the patient's seizure disorder.
Impact on Depression and Seizures:
Remarkably, the patient's depression severity significantly decreased, as evidenced by reductions in both the Montgomery Asberg Depression Rating Scale (MADRS) and the Patient Health Questionnaire-9 (PHQ-9) scores. Importantly, her seizure frequency remained unchanged throughout the treatment, indicating the safety of iTBS in this context.
Safety and Efficacy from Other Studies
Risk of Seizures:
The case report emphasizes the low risk of seizure induction by iTBS, even in patients with preexisting seizure disorders. This finding is crucial, as it supports the broader application of TMS in treating psychiatric conditions in this demographic.
Other Larger Studies:
Transcranial Magnetic Stimulation (TMS) is generally considered a safe treatment with a low risk of inducing seizures. Larger studies indicate that the overall risk of seizure from TMS is comparable to that of psychotropic medications, with specific studies showing a seizure incidence of less than 0.03% per session. A comprehensive review and meta-analysis of TMS safety confirmed these findings, reporting seizure risks ranging from 0% to 3.6% depending on the type of TMS applied, with most studies indicating a risk well below 1%. Furthermore, a large survey across various clinical settings involving over half a million TMS sessions reported an overall seizure rate of 0.31 per 10,000 sessions, underscoring the rarity of such events. These studies collectively highlight the importance of adhering to established safety protocols to maintain this low risk profile.
Conclusion
The insights gained from this case report enable Dr. Danish and his practitioners at Philadelphia Integrative Psychiatry to make informed and balanced decisions regarding the use of TMS in patients with seizure disorders. This research underscores the potential of TMS to offer hope and relief to patients with complex medical and psychiatric needs, furthering our commitment to providing cutting-edge, personalized psychiatric care.
For further reading on the safety and efficacy of TMS in patients with seizure disorders and treatment-resistant depression, please refer to the following articles:
Stultz DJ, Osburn S, Burns T, Pawlowska-Wajswol S, Walton R. "Transcranial magnetic stimulation (TMS) safety with respect to seizures: a literature review." Neuropsychiatric Dis Treat 2020;16:2989–3000. https://doi.org/10.2147/NDT.S276635.
Conway CR, Udaiyar A, Schachter SC. "Neurostimulation for depression in epilepsy." Epilepsy Behav 2018;88S:25–32. https://doi.org/10.1016/j.yebeh.2018.06.007.
Dobek CE, Blumberger DM, Downar J, Daskalakis ZJ, Vila-Rodriguez F. "Risk of seizures in transcranial magnetic stimulation: a clinical review to inform consent process focused on bupropion." Neuropsychiatric Dis Treat 2015;11: 2975–87. https://doi.org/10.2147/NDT.S91126.
Pereira LS, Müller VT, da Mota Gomes M, Rotenberg A, Fregni F. "Safety of repetitive transcranial magnetic stimulation in patients with epilepsy: a systematic review." Epilepsy Behav 2016;57(Pt A):167–76. https://doi.org/10.1016/j.yebeh.2016.01.015.
Lerner AJ, Wassermann EM, Tamir DI. "Seizures from transcranial magnetic stimulation 2012-2016: results of a survey of active laboratories and clinics." Clin Neurophysiol 2019;130(8):1409–16.https://doi.org/10.1016/j.clinph.2019.03.016.
