| Paper authors: | Christine E. Dobek, Daniel M. Blumberger, Jonathan Downar, Zafiris J. Daskalakis, Fidel Vila-Rodriguez |
| Year of paper publication: | 2015 |
| Post authors: | Caleb Pozdnikoff, Sarah Kesler, Fidel Vila-Rodriguez |
| Download the research article: | Dobek et al. (2015) Risk of seizures in transcranial magnetic stimulation: a clinical review to inform consent process focused on bupropion |
Introduction
Repetitive transcranial stimulation (rTMS) is a brain stimulation technique that is widely regarded as a safe treatment for depression. While rTMS is typically well tolerated, side effects do happen but diminish over time. Common side effects include fatigue, pain or discomfort during stimulation, headache, and much more rarely, seizure. Would this “safe” designation change if certain medications were combined with rTMS?
The researchers of this paper attempted to determine if seizure risk increased when receiving rTMS and taking an antidepressant called bupropion (Wellbutrin). Bupropion is also generally considered to be safe, but there is some evidence that when taken at higher doses (without rTMS) and with certain formulations of the drug (for example, extended release or quick release variations), the seizure risk may increase.
To address if bupropion increases seizure risk specifically during rTMS, a review of all the available literature that mentioned rTMS, bupropion, and seizures was conducted.
Methods
This study included 15 people with moderate or severe treatment-resistant depression. There were also 10 “healthy controls” The researchers conducted a type of literature review called a systematic review. This entails a deep-dive into all papers that could be relevant to the topic at hand. The researchers searched specific databases using keywords (as well as their synonyms) that are relevant to the topic, like “rTMS” or “TMS” and “seizures” among others. Using this strategy, all cases of rTMS and seizures were reviewed.
The next step of a systematic review is to read the abstracts of all the papers in your search results and get rid of the ones that are obviously irrelevant. Once this is done, the full papers are reviewed by the researchers to make sure they have the relevant information for their study question. The final step of collecting the data is to extract all the relevant details from the papers to a database so it can be processed.
Results
- Researchers found and reviewed 25 cases of seizures induced during rTMS treatment
- From these 25 cases, zero people were taking bupropion at the time of their seizure
- One separate report from the U.S. Food and Drug Administration involved a patient on bupropion, but she was taking other seizure threshold lowering medications and was sleep deprived (known risk factors for rTMS-induced seizures)
- From these 25 cases, zero people were taking bupropion at the time of their seizure
- Common risk factors for seizure during rTMS were seen in these 25 cases, including sleep deprivation, taking multiple medications, and having a pre-existing neurological condition
- The evidence from this review is consistent with evidence from rTMS clinics giving treatments to patients who are taking bupropion, and other studies investigating bupropion and rTMS
Conclusion
In summary, while rTMS-induced seizures are uncommon and may be linked to factors like sleep deprivation, taking multiple medications, or pre-existing neurological conditions, this review found no cases of rTMS-induced seizures in patients taking bupropion alone. This suggests that taking bupropion should not be considered a reason to avoid rTMS treatment.