title: Tolerability and safety of high daily doses of repetitive transcranial magnetic stimulation in healthy young men.
abstract: Repetitive transcranial magnetic stimulation (rTMS) is an experimental technology that involves a powerful magnetic pulse applied to the scalp, which is sufficient to cause neuronal depolarization. Transcranial magnetic stimulation has been used in treatment studies for psychiatric disorders, primarily unipolar depression, and as a tool to map brain function. Although thousands of rTMS sessions have been given with few side effects, rTMS can produce serious adverse effects such as an unintended seizure. Safety guidelines for frequency, duration, and intensity of rTMS have aided in the prevention of such adverse side effects. However, the total dose (number of stimuli) able to be delivered safely to human subjects within a day or within a week has not been established. For example, previous rTMS studies as a treatment for depression consisted of delivering 800 to 3,000 magnetic pulses per day, with 8000 to 30,000 magnetic pulses over 2 to 3 weeks. This study examined whether high doses of rTMS within a day or over a week would produce significant side effects. As part of a study to examine rTMS effects in sleep deprivation, we exposed healthy men to 12,960 magnetic pulses a day for up to 3 days in 1 week. This equals 38,880 magnetic pulses over 1 week, which is likely one of the largest exposures of TMS to date. Despite this intense treatment regimen, we failed to produce significant side effects. Doses of up to 12,960 pulses per day appear safe and tolerable in healthy young men.
authors.affiliation: Brain Stimulation Laboratory, Department of Psychiatry, Medical University of South Carolina, Charleston, 29425, USA. andersob@musc.edu
authors.forename: Berry
authors.initials: B
authors.lastname: Anderson
authors.forename: Alexander
authors.initials: A
authors.lastname: Mishory
authors.forename: Ziad
authors.initials: Z
authors.lastname: Nahas
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Borckardt
authors.forename: Kaori
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Komal
authors.initials: K
authors.lastname: Rastogi
authors.forename: Mark S
authors.initials: MS
authors.lastname: George
mesh_terms: D000293:Adolescent; D000328:Adult; D001927:Brain Diseases / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012449:Safety; D050781:Transcranial Magnetic Stimulation