Abstract
Transcranial magnetic stimulation (TMS) is a rapidly developing method of neuromodulation. The use of TMS has increased significantly in both research and clinical practice. This allows not only to better understand this method, but also assess possible risks and consequences for both healthy individuals and patients. In 1998 and 2009 safety, ethical considerations, and application guidelines for the use of TMS in clinical practice and research were published. These recommendations are now the basis for safe application of the method in clinical practice and research. Safety of brain stimulation includes several aspects: the prevention and treatment of adverse effects, the strategy of patient and stimulation protocols selection, as well as safety and monitoring procedures. The most common adverse effects of TMS include headache and neck pain, syncope, transient hearing impairment. The risk of epileptic seizureis extremely low and can be minimized by careful selection of patients and the use of safe stimulation protocols. Careful selection of patients is important, taking into account a large number of factors that influence the risk of adverse effects. These factors are considered in the questionnaires to identify limitations and absolute or relative contraindications to TMS. Another important part of TMS safety is the choice of the stimulation protocol and parameters such as intensity, frequency, duration of one train of stimuli, and the interstimulus interval. Currently, the recommended limits of stimulation parameters are covered in the safety guidelines. It is also necessary to follow the procedure, including the monitoring the patient's condition during TMS and the providing qualified assistance in case of adverse effects.
Highlights
Ключевые слова: транскраниальная магнитная стимуляция, неинвазивная стимуляция мозга, безопасность, побочный эффект, противопоказание, эпилептический приступ, головная боль, синкопальное состояние, беременность, детский возраст
Careful selection of patients is important, taking into account a large number of factors that influence the risk of adverse effects
These factors are considered in the questionnaires to identify limitations and absolute or relative contraindications to Transcranial magnetic stimulation (TMS)
Summary
Безопасность транскраниальной магнитной стимуляции: обзор международных рекомендаций и новые данные. Careful selection of patients is important, taking into account a large number of factors that influence the risk of adverse effects These factors are considered in the questionnaires to identify limitations and absolute or relative contraindications to TMS. Физические факторы безопасности транскраниальной магнитной стимуляции К физическим факторам безопасности ТМС относятся локальное нагревание кожи и ткани мозга и намагничивание имплантированных металлических устройств (при их наличии). Моделирование действия переменного магнитного поля на перечисленные устройства в условиях ex vivo показало, что ТМС не влияет на работу электродов для глубокой и корковой стимуляции мозга, устройств стимуляции блуждающего нерва и может безопасно использоваться при наличии имплантов перечисленного типа [10,11,12,13]. В связи с этим сегодня присутствие электродов для поверхностной и глубокой стимуляции мозга рассматривается как относительное противопоказание к ТМС – проведение процедуры возможно только при наличии веских клинических показаний. Adverse effects of TMS (adapted from [3], revised and updated)
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