RTMS Induced Seizure Of A Patient With Adolescent Onset Depression: A Case Report And Literature Review

Transcranial Magnetic Stimulation (TMS) has intrigued worldwide interest as an investigational and therapeutic tool in neuropsychiatry. One of the study focuses is repetitive transcranial magnetic stimulation (rTMS) as a treatment for psychiatric disorders, in particular, depression. rTMS has been advocated as a therapeutic means for depression in adults by the U.S. Food and Drug Administration (FDA) in 2008[1] and safety guidelines has been established by researchers[2]. However, relative research and data are insufficient concerning young people under 18. Thus, large number of studies and trials are needed to assure the safety of the application for this age group first. Our case report describes a 15-year-old female depressive adolescent who suffered seizure and hypomania at the first session of rTMS (parameters contain: frequency of 10 Hz, intensity of 80%of motor threshold, stimulation duration of 4 seconds per train, intertrain interval of 26 seconds, total of 800 pulses/d) concomitant to sertraline(100mg/day). Subsequent EEG showed no abnormalities and no long-term complication was founded. We suggest that rTMS should be cautiously applied for adolescents with depressive disorder, particularly combination with antidepressant. We reviewed relative English-language studies and our discussion focuses on safety considerations of rTMS applied in people under 18.