Safety, Ethical Considerations, and Application Guidelines

Por: Estimulação Magnética Transcraniana repetitiva (EMTr)  24/09/2009
Palavras-chave: Depressão, Tratamento Dos Transtornos De Humor, Transtorno De Ansiedade Generalizada


This article is based on a consensus conference, which took place in Certosa di Pontignano, Siena

(Italy) on March 7-9, 2008, intended to update the previous safety guidelines for the application of

transcranial magnetic stimulation (TMS) in research and clinical settings.

Over the past decade the scientific and medical community has had the opportunity to evaluate the

safety record of research studies and clinical applications of TMS and repetitive TMS (rTMS). In these

years the number of applications of TMS has grown impressively, new paradigms of stimulation have

been developed (e.g. arrhythmic rTMS) and technical advances have led to new device designs and

to the real-time integration of TMS with electronencephalography (EEG), positron emission

tomography (PET) and functional magnetic resonance imaging (fMRI). Thousands of healthy subjects

and patients with various neurological and psychiatric diseases have undergone TMS allowing to

better assess relative risks. The occurrence of seizures (i.e., the most serious TMS-related acute

adverse effect) has been extremely rare, with most of the few new cases receiving TMS protocols

exceeding previous guidelines, often in patients under treatment with drugs which potentially lower the

seizure threshold.

The present updated guidelines review issues of risk and safety of conventional TMS protocols,

address the undesired effects and risks of emerging TMS interventions, the applications of TMS in

patients with implanted brain electrodes, and safety aspects of TMS in neuroimaging environments.

We cover recommended limits of stimulation parameters and other important precautions, monitoring

of subjects, expertise of the rTMS team, and ethical issues. While all the recommendations here are

expert based, they utilize published data to the extent possible.

A Consensus Statement from the International Workshop on “Present and Future of TMS: Safety and Ethical Guidelines”, Siena, March 7-9, 2008 Simone Rossi1, Mark Hallett2, Paolo M. Rossini3 and Alvaro Pascual Leone4

Palavras-chave: Antidepressivo, Clínica de Estimulação Magnética, Depressão, EMTr, Estimulação Magnética, Estimulacao magnetica transcraniana repetitiva, Psiquiatria, Transtorno De Ansiedade Generalizada, Tratamento Dos Transtornos De Humor,

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