Safety of repetitive transcranial magnetic stimulation in patients with implanted cortical electrodes. An ex-vivo study and report of a case

Nicolás M Phielipp; Utpal Saha; Tejas Sankar; Akihiro Yugeta; Robert Chen

doi:10.1016/j.clinph.2017.01.021

Safety of repetitive transcranial magnetic stimulation in patients with implanted cortical electrodes. An ex-vivo study and report of a case

Clin Neurophysiol. 2017 Jun;128(6):1109-1115. doi: 10.1016/j.clinph.2017.01.021. Epub 2017 Feb 13.

Authors

Nicolás M Phielipp¹, Utpal Saha², Tejas Sankar³, Akihiro Yugeta⁴, Robert Chen⁵

Affiliations

¹ Division of Neurology, Department of Medicine, University of Toronto, Division of Brain Imaging and Behaviour - Systems Neuroscience, Krembil Research Institute. 7MC-411, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. Electronic address: nphielip@uci.edu.
² Division of Neurology, Department of Medicine, University of Toronto, Division of Brain Imaging and Behaviour - Systems Neuroscience, Krembil Research Institute. 7MC-411, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. Electronic address: usaha@uhnresearch.ca.
³ Division of Neurosurgery, Faculty of Medicine, University of Alberta, 2D1.02 WMC Health Sciences Centre, 8440-112 Street NW, Edmonton, Alta. T6G 2B7, Canada. Electronic address: tsankar@ualberta.ca.
⁴ Division of Neurology, Department of Medicine, University of Toronto, Division of Brain Imaging and Behaviour - Systems Neuroscience, Krembil Research Institute. 7MC-411, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. Electronic address: yugetaa-tky@umin.ac.jp.
⁵ Division of Neurology, Department of Medicine, University of Toronto, Division of Brain Imaging and Behaviour - Systems Neuroscience, Krembil Research Institute. 7MC-411, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. Electronic address: robert.chen@uhn.ca.

PMID: 28259678
DOI: 10.1016/j.clinph.2017.01.021

Abstract

Objective: To evaluate the safety of repetitive transcranial magnetic stimulation (rTMS) in patients with implanted subdural cortical electrodes.

Methods: We performed ex-vivo experiments to test the temperature, displacement and current induced in the electrodes with single pulse transcranial magnetic stimulation (TMS) from 10 to 100% of stimulator output and tested a typical rTMS protocol used in a clinical setting. We then used rTMS to the motor cortex to treat a patient with refractory post-herpetic neuralgia who had previously been implanted with a subdural motor cortical electrode for pain management. The rTMS protocol consisted of ten sessions of 2000 stimuli at 20Hz and 90% of resting motor threshold.

Results: The ex-vivo study showed an increase in the coil temperature of 2°C, a maximum induced charge density of 30.4μC/cm²/phase, and no electrode displacement with TMS. There was no serious adverse effect associated with rTMS treatment of the patient. Cortical tremor was observed in the intervals between trains of stimuli during one treatment session.

Conclusions: TMS was safe in a patient with implanted Medtronic Resume II electrode (model 3587A) subdural cortical electrode.

Significance: TMS may be used as a therapeutic, diagnostic or research tool in patients this type of with implanted cortical electrodes.

Keywords: Cortical electrodes; Safety; TMS; rTMS.

Publication types

Case Reports
Evaluation Study

MeSH terms

Electrodes, Implanted / adverse effects*
Humans
Male
Middle Aged
Neuralgia, Postherpetic / therapy
Transcranial Magnetic Stimulation / adverse effects*
Transcranial Magnetic Stimulation / instrumentation
Transcranial Magnetic Stimulation / methods