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Distinguishing Convulsive Syncope From Seizure Induced by Repetitive Transcranial Magnetic Stimulation: A Case Report.

Publication ,  Journal Article
Mukhtar, F; Feuer, E; Beynel, L; Jones, E; Regenold, WT; Lisanby, SH
Published in: J ECT
December 1, 2023

Repetitive transcranial magnetic stimulation (rTMS) is Food and Drug Administration cleared for clinical use in treatment-resistant depression and a growing list of other disorders. The clinical uptake of rTMS has been facilitated by its relatively benign adverse-effect profile compared with other treatment modalities. Seizure is a rare but serious adverse event that has been reported with rTMS, when dosage exceeds safety guidelines or in individuals at increased risk for seizure. Fortunately, most rTMS-induced seizures are typically transient, with no adverse sequelae, but they may lead to treatment discontinuation. Seizure is not the only cause of loss of conscious and abnormal movements induced by rTMS. Convulsive syncope, a more common adverse event that involves loss of consciousness associated with myoclonic movements, can be difficult to differentiate from an rTMS-induced seizure. We report the case of a 52-year-old man with no known seizure risk factors, enrolled in an institutional review board-approved research study who developed what appeared to be a convulsive syncopal episode lasting 10 to 15 seconds during day 2 of a 30-day rTMS protocol (10 Hz, 120% of motor threshold, 4-second pulse train, 26-second intertrain interval, 3000 pulses per session), with no adverse sequelae. The patient's history, screening, physical examination, pertinent laboratory, neurology consult, electroencephalogram, and imaging findings are discussed. This case demonstrates that distinguishing between convulsive syncope and rTMS-induced seizure can be a diagnostic challenge. Clinicians and researchers delivering rTMS should be familiar with the risk factors for rTMS-induced seizures and rTMS-induced convulsive syncope, to screen for predisposing factors and to manage these rare adverse events if they occur.

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Published In

J ECT

DOI

EISSN

1533-4112

Publication Date

December 1, 2023

Volume

39

Issue

4

Start / End Page

271 / 273

Location

United States

Related Subject Headings

  • Transcranial Magnetic Stimulation
  • Syncope
  • Seizures
  • Risk Factors
  • Psychiatry
  • Middle Aged
  • Male
  • Humans
  • Electroconvulsive Therapy
  • 5203 Clinical and health psychology
 

Citation

APA
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Mukhtar, F., Feuer, E., Beynel, L., Jones, E., Regenold, W. T., & Lisanby, S. H. (2023). Distinguishing Convulsive Syncope From Seizure Induced by Repetitive Transcranial Magnetic Stimulation: A Case Report. J ECT, 39(4), 271–273. https://doi.org/10.1097/YCT.0000000000000959
Mukhtar, Fahad, Elyssa Feuer, Lysianne Beynel, Eudora Jones, William T. Regenold, and Sarah H. Lisanby. “Distinguishing Convulsive Syncope From Seizure Induced by Repetitive Transcranial Magnetic Stimulation: A Case Report.J ECT 39, no. 4 (December 1, 2023): 271–73. https://doi.org/10.1097/YCT.0000000000000959.
Mukhtar F, Feuer E, Beynel L, Jones E, Regenold WT, Lisanby SH. Distinguishing Convulsive Syncope From Seizure Induced by Repetitive Transcranial Magnetic Stimulation: A Case Report. J ECT. 2023 Dec 1;39(4):271–3.
Mukhtar, Fahad, et al. “Distinguishing Convulsive Syncope From Seizure Induced by Repetitive Transcranial Magnetic Stimulation: A Case Report.J ECT, vol. 39, no. 4, Dec. 2023, pp. 271–73. Pubmed, doi:10.1097/YCT.0000000000000959.
Mukhtar F, Feuer E, Beynel L, Jones E, Regenold WT, Lisanby SH. Distinguishing Convulsive Syncope From Seizure Induced by Repetitive Transcranial Magnetic Stimulation: A Case Report. J ECT. 2023 Dec 1;39(4):271–273.

Published In

J ECT

DOI

EISSN

1533-4112

Publication Date

December 1, 2023

Volume

39

Issue

4

Start / End Page

271 / 273

Location

United States

Related Subject Headings

  • Transcranial Magnetic Stimulation
  • Syncope
  • Seizures
  • Risk Factors
  • Psychiatry
  • Middle Aged
  • Male
  • Humans
  • Electroconvulsive Therapy
  • 5203 Clinical and health psychology