Principles of patients selection and safety of repetitive transcranial magnetic stimulation – position statement of the Section of Biological Psychiatry of the Polish Psychiatric Association

Abstract

Transcranial magnetic stimulation (TMS) is a method of noninvasive brain stimulation developed since the 1980s. Repetitive transcranial magnetic stimulation (rTMS) is one of the methods of noninvasive brain stimulation, which is increasingly used to treat psychiatric disorders. Recent years witnessed a dynamic growth in the number of sites offering therapy with rTMS and of the interest of patients in this method in Poland. This article presents the position statement of the working group of the Section of Biological Psychiatry of the Polish Psychiatric Association concerning the proper patients selection and safety of use of rTMS in the therapy of psychiatric conditions. Before starting to use rTMS, the involved personnel should undergo a period of training in one of the centers with relevant experience. Equipment dedicated to perform rTMS should be appropriately certified. The main therapeutic indication is depression, including drug-resistant patients. rTMS may also be used in obsessive-compulsive disorder, negative symptoms and auditory hallucinations in schizophrenia, nicotine addiction, cognitive and behavioral disturbances in Alzheimer’s disease, and post-traumatic stress disorder. The strength of magnetic stimuli and the overall dosing of stimulation must be based on the recommendations of the International Federation of Clinical Neurophysiology. The main contraindications are the metal elements in the body, especially medical electronic devices near the stimulating coil, epilepsy, hearing loss, structural changes in the brain, which may be associated with epileptogenic foci, pharmacotherapy, which lowers the seizure threshold, and pregnancy. The main side effects are induction of epileptic seizure, syncope, pain and discomfort during stimulation, as well as induction of manic or hypomanic episodes. The respective management is described in the article.