title: Risk of seizures in transcranial magnetic stimulation: a clinical review to inform consent process focused on bupropion.
abstract: OBJECTIVE
  When considering repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder, clinicians often face a lack of detailed information on potential interactions between rTMS and pharmacotherapy. This is particularly relevant to patients receiving bupropion, a commonly prescribed antidepressant with lower risk of sexual side effects or weight increase, which has been associated with increased risk of seizure in particular populations. Our aim was to systematically review the information on seizures occurred with rTMS to identify the potential risk factors with attention to concurrent medications, particularly bupropion.
  
  
  METHODS
  We conducted a systematic review through the databases PubMed, PsycINFO, and EMBASE between 1980 and June 2015. Additional articles were found using reference lists of relevant articles. Reporting of data follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
  
  
  METHODS
  Two reviewers independently screened articles reporting the occurrence of seizures during rTMS. Articles reporting seizures in epilepsy during rTMS were excluded. A total of 25 rTMS-induced seizures were included in the final review.
  
  
  METHODS
  Data were systematically extracted, and the authors of the applicable studies were contacted when appropriate to provide more detail about the seizure incidents.
  
  
  RESULTS
  Twenty-five seizures were identified. Potential risk factors emerged such as sleep deprivation, polypharmacy, and neurological insult. High-frequency-rTMS was involved in a percentage of the seizures. None of these seizures reported had patients taking bupropion in the literature review. One rTMS-induced seizure was reported from the Food and Drug Administration in a sleep-deprived patient who was concurrently taking bupropion, sertraline, and amphetamine.
  
  
  CONCLUSIONS
  During the consent process, potential risk factors for an rTMS-induced seizure should be carefully screened for and discussed. Data do not support considering concurrent bupropion treatment as contraindication to undergo rTMS.
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Non-Invasive Neurostimulation Therapies (NINET) Laboratory, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Dobek
authors.affiliation: Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Blumberger
authors.affiliation: Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Downar
authors.affiliation: Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada.
authors.forename: Zafiris J
authors.initials: ZJ
authors.lastname: Daskalakis
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Non-Invasive Neurostimulation Therapies (NINET) Laboratory, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Fidel
authors.initials: F
authors.lastname: Vila-Rodriguez
keywords: bupropion; consent process; interaction; repetitive transcranial magnetic stimulation; seizures