The Effect of Daily Prefrontal Repetitive Transcranial Magnetic Stimulation Over Several Weeks on Resting Motor Threshold

Background The resting motor threshold (rMT) is an important factor in the selection of treatment intensity for patients receiving repetitive transcranial magnetic stimulation (rTMS). In many clinical studies to date, because of the concerns about potential drift, the rMT has been routinely remeasured weekly or every fifth session. Objective Our aim is to investigate whether ongoing treatment with rTMS affects the rMT, the degree of change, and whether frequent remeasurement is needed. Methods Clinical data were drawn from 50 medication-free patients who were receiving treatment for major depression with rTMS in a large US National Institutes of Health (NIH)-sponsored multisite study. Four measurements of rMT were obtained, including before and after the double-blind phase, followed by weekly measurements during the open phase. Active treatment consisted of 75 four-second trains of 10-Hz stimulation applied over 37.5 minutes with the coil over the left dorsolateral prefrontal cortex (DLPFC) at 120% rMT. Results For the group as a whole, there was no significant change in the rMT during a minimum of 2 weeks of treatment with prefrontal rTMS ( P = .911, 1-way analysis of variance). The average within-subject coefficient of variation was 6.58%. On average, the last rMT was 2.45% less than the baseline rMT (range: 32.3% increase, 40.6% decrease). Conclusions Daily left prefrontal rTMS over several weeks as delivered in this trial does not cause systematic changes in rMT. Although most subjects had less than 10% variance in rMT over time, five subjects had changes of approximately 20% from baseline, raising dosing and safety issues if undetected. We recommend that clinical trials of rTMS have periodic retesting of rMT, especially if the dose is at or near the edge of the TMS safety tables.