Journal: Brain Stimulation (2015)
Authors: A Tendler, L DeLuca, M DeLuca, E Sisko, M Turcone, N Rodriguez
Background:
The only serious side effect of transcranial magnetic stimulation (TMS) is the onset of a seizure during the stimulation. To avoid this adverse event, clinical trials have excluded patients on Clozapine, which lowers the seizure threshold. Several small reports demonstrate the safe use of 1 HZ repetitive TMS (rTMS) in patients taking Clozapine. However, 1 HZ rTMS is an inhibitory protocol, which is unlikely to induce a seizure. There are no published reports on the safety of high frequency rTMS or deep TMS (dTMS) concomitant with Clozapine.
Objective:
To report on safety of high frequency dTMS treatment concomitant with Clozapine.
Methods:
The authors completed a retrospective chart review for high frequency (10-20 Hz) rTMS and dTMS patients who were concomitantly on clozapine. Nine patients received TMS while taking clozapine. Of these patients, four received only rTMS, two received only dTMS, and three were treated with both dTMS and rTMS.
Results:
The nine patients received a combined total of 643 days of high frequency rTMS or dTMS at or above 120% of the motor threshold. No seizures occurred, and there was no trend in reduction of the motor threshold with Clozapine dosage increases.
Conclusions:
High frequency supra threshold rTMS and dTMS is safe in patients on Clozapine. Clozapine dosage adjustments do not appear to correlate with motor threshold changes. Clozapine should not be a reason to avoid TMS, and it should not be an exclusion criterion in future TMS clinical trials for schizophrenia, bipolar or Parkinson’s Disease.
Full Publication: Safety of High Frequency rTMS and dTMS with Clozapine: Case Series – Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation
