Safety of repetitive transcranial magnetic stimulation in patients with implanted cortical electrodes. An ex-vivo study and report of a case

Abstract Objective To evaluate the safety of repetitive transcranial magnetic stimulation (rTMS) in patients with implanted subdural cortical electrodes. Methods We performed ex-vivo experiments to test the temperature, displacement and current induced in the electrodes with single pulse transcranial magnetic stimulation (TMS) from 10 to 100% of stimulator output and tested a typical rTMS protocol used in a clinical setting. We then used rTMS to the motor cortex to treat a patient with refractory post-herpetic neuralgia who had previously been implanted with a subdural motor cortical electrode for pain management. The rTMS protocol consisted of ten sessions of 2000 stimuli at 20 Hz and 90% of resting motor threshold. Results The ex-vivo study showed an increase in the coil temperature of 2 °C, a maximum induced charge density of 30.4 μC/cm 2 /phase, and no electrode displacement with TMS. There was no serious adverse effect associated with rTMS treatment of the patient. Cortical tremor was observed in the intervals between trains of stimuli during one treatment session. Conclusions TMS was safe in a patient with implanted Medtronic Resume II electrode (model 3587A) subdural cortical electrode. Significance TMS may be used as a therapeutic, diagnostic or research tool in patients this type of with implanted cortical electrodes.