title: Case report of vasovagal syncope associated with single pulse transcranial magnetic stimulation in a healthy adult participant.
abstract: BACKGROUND
  Non-invasive brain stimulation-related seizures or syncopal events are rare. However, we report on a syncopal event in a healthy female during a transcranial magnetic stimulation single-pulse testing session.
  
  
  METHODS
  A 47-year-old healthy female presented for a transcranial magnetic stimulation session involving single-pulse assessment of cortical excitability. During the session, the participant appeared to have a brief event involving fainting and myoclonic jerks of the upper extremities. Orthostatic assessment was performed after the event and physician evaluation determined that this was a vasovagal syncopal event. The ethical aspects of this neurophysiology testing protocol were reviewed by the University of Minnesota Institutional Review Board (IRB), and formal IRB approval was deemed unnecessary for single-pulse assessment of healthy control participants not directly involved in a research study. Informed consent was obtained by the participant, including review of potential adverse events.
  
  
  CONCLUSIONS
  Although rare and rarely reported, vasovagal syncopal events surrounding non-invasive brain stimulation do occur. Thorough pre-screening should incorporate assessment of history of syncope and a plan for risk mitigation if such an event should occur. A complete assessment of the impact of stimulation on the autonomic nervous system is unknown. As such studies expand into patients with myriad neurologic diagnoses, further studies on this effect, in both healthy control and patient populations, are warranted. Such knowledge could contribute to identification of the optimal study participant, and improvements in techniques of stimulation administration.
authors.affiliation: University of Minnesota Medical School, Rehabilitation Science, 420 Delaware Street SE, MMC 388, Minneapolis, MN, 55455, USA. gillick@umn.edu.
authors.forename: Bernadette T
authors.initials: BT
authors.lastname: Gillick
authors.affiliation: University of Minnesota Medical School, Rehabilitation Science, 420 Delaware Street SE, MMC 388, Minneapolis, MN, 55455, USA. rich1038@umn.edu.
authors.forename: Tonya
authors.initials: T
authors.lastname: Rich
authors.affiliation: Institute for Engineering in Medicine, University of Minnesota Non-Invasive Neuromodulation Laboratory, MnDRIVE Brain Conditions, 420 Delaware Street SE, MMC 388, Minneapolis, MN, 55455, USA. mchen@umn.edu.
authors.forename: Mo
authors.initials: M
authors.lastname: Chen
authors.affiliation: University of Minnesota Medical School, Department of Neurology, Minneapolis, MN, 55455, USA. gmeekins@umn.edu.
authors.forename: Gregg D
authors.initials: GD
authors.lastname: Meekins
mesh_terms: D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008875:Middle Aged; D019462:Syncope, Vasovagal / Q000209:etiology*; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects*
keywords: Adverse events.; Non-invasive brain stimulation; Transcranial magnetic stimulation; Vasovagal syncope