One advantage of rTMS over other forms of brain stimulation such as Electroconvulsive Therapy (ECT) is that the patient does not need anaesthesia, as well as the fact that seizures need not be induced. Therefore, rTMS has a much safer risk profile compared to ECT. The table below shows all the known adverse effects reported for rTMS. Common side effects of rTMS are headache, twitching of the facial muscles and auditory impairments, during the actual treatment. With respect to severe acute adverse effects, induction of seizures though rare, has been known to occur. In the early days of rTMS accidental seizures were reported and thought to be caused by overstepping of safety limits now in place. However, in their report on the safety of rTMS, Rossi et al. conclude that the risk of rTMS to induce seizures is very low, taking into account the large amount of study data that exists from 1998. When adverse effects occur, they are usually mild and transient and rTMS is considered to be a safe therapeutic intervention
Guidelines for the use of rTMS were originally drawn up by Wassermann in 1998 and updated by Rossi et al. together with the Safety or TMS Consensus Group in 2009:
Dr Beppe Micallef-Trigona is a Maltese Psychiatrist and Visiting Lecturer in the Department of Psychiatry, Faculty of Medicine and Surgery at the University of Malta. He currently works as a consultant psychiatrist with the Ministry of Defence in the UK.