Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research

被引：3883

作者：

Rossi, Simone ^{[1
]}

Hallett, Mark ^{[2
]}

Rossini, Paolo M. ^{[3
,4
]}

Pascual-Leone, Alvaro ^{[5
,6
]}

Avanzini, Giuliano ^{[7
]}

Bestmann, Sven ^{[8
]}

Berardelli, Alfredo ^{[9
,10
]}

Brewer, Carmen ^{[11
]}

Canli, Turhan ^{[12
]}

Cantello, Roberto ^{[13
]}

Chen, Robert ^{[14
,15
]}

Classen, Joseph ^{[16
]}

Demitrack, Mark ^{[17
]}

Di Lazzaro, Vincenzo ^{[18
]}

Epstein, Charles M. ^{[19
]}

George, Mark S. ^{[20
]}

Fregni, Felipe ^{[21
]}

Ilmoniemi, Risto ^{[22
]}

Jalinous, Reza ^{[23
]}

Karp, Barbara ^{[24
]}

Lefaucheur, Jean-Pascal ^{[25
]}

Lisanby, Sarah ^{[26
]}

Meunier, Sabine ^{[27
]}

Miniussi, Carlo ^{[28
]}

Miranda, Pedro ^{[29
]}

Padberg, Frank ^{[30
]}

Paulus, Walter ^{[31
]}

Peterchev, Angel ^{[32
,33
]}

Porteri, Corinna ^{[34
]}

Provost, Miriam ^{[35
]}

Quartarone, Angelo ^{[36
]}

Rotenberg, Alexander ^{[37
]}

Rothwell, John ^{[38
]}

Ruohonen, Jarmo ^{[39
]}

Siebner, Hartwig ^{[40
]}

Thut, Gregor ^{[41
]}

Valls-Sole, Josep ^{[42
]}

Walsh, Vincent ^{[43
]}

Ugawa, Yoshikatzu ^{[44
]}

Zangen, Abraham ^{[45
]}

Ziemann, Ulf ^{[46
]}

机构：

[1] Univ Siena, Dipartimento Neurosci, Sez Neurol, I-53100 Siena, Italy

[2] NINDS, Human Motor Control Sect, NIH, Bethesda, MD 20892 USA

[3] Univ Campus Biomed, Rome, Italy

[4] Casa Cura S Raffaele, Cassino, Italy

[5] Beth Israel Deaconess Med Ctr, Berenson Allen Ctr Noninvas Brain Stimulat, Boston, MA 02215 USA

[6] Harvard Univ, Sch Med, Boston, MA USA

[7] Ist Nazl Neurol Carlo Besta, Neurocienze Clin, Milan, Italy

[8] UCL Inst Neurol, Sobell Dept Motor Neurosci & Movement, London, England

[9] Univ Roma La Sapienza, Dept Neurol Sci, Rome, Italy

[10] Univ Roma La Sapienza, Neuromed Inst, Rome, Italy

[11] Natl Inst Deafness & Other Commun Disorders, NIH, Bethesda, MD USA

[12] SUNY Stony Brook, Dept Psychol, New York, NY USA

[13] Univ Piemonte Orientale, Sez Neurol, Dipartimento Med Clin & Sperimentale, Novara, Italy

[14] Univ Toronto, Toronto Western Res Inst, Toronto, ON, Canada

[15] Univ Toronto, Dept Med, Div Neurol, Toronto, ON, Canada

[16] Univ Leipzig, Dept Neurol, Leipzig, Germany

[17] Neuronetics Inc, Malvern, PA USA

[18] Univ Cattolica Sacro Cuore, Inst Neurol, Rome, Italy

[19] Emory Univ, Sch Med, Dept Neurol, Atlanta, GA USA

[20] Med Univ S Carolina, Charleston, SC USA

[21] Beth Israel Deaconess Med Ctr, Harvard Med Sch, Berenson Allen Ctr Noninvasive Brain Stimulat, Boston, MA USA

[22] Dept Biomed Eng & Computat Sci BECS, Helsinki, Finland

[23] Magstim Co, Boston, MA USA

[24] Combined NeuroSci IRB, NIH, Bethesda, MD USA

[25] Hop Henri Mondor, Explorat Fonct, Serv Physiol, Creteil, France

[26] Columbia Univ, Coll Phys & Surg, New York State Psychiat Inst, Div Brain Stimulat & Therapeut Modulat, New York, NY USA

[27] Hop La Pitie Salpetriere, Serv Readaptat Fonct, Paris, France

[28] IRCCS San Giovanni Dio Fatebenefratelli, Cognit Neurosci Sect, Brescia, Italy

[29] Univ Lisbon, Fac Sci, Inst Biophys & Biomed Engn, Lisbon, Portugal

[30] Univ Munich, Klin Psychiat & Psychotherapie, Munich, Germany

[31] Univ Gottingen, Dept Clin Neurophysiol, Gottingen, Germany

[32] Columbia Univ, Dept Psychiat, Div Brain Stimulat & Therapeuc Modulat, New York, NY USA

[33] Columbia Univ, Dept Elect Engn, New York, NY USA

[34] IRCCS San Giovanni Dio Fatebenefratelli, Bioethics Unit, Brescia, Italy

[35] Med Devices Biol Consulting Grp Inc, Athens, GA USA

[36] Univ Messina, Dipartimento Neurosci Sci Psichiat & Anestesiol, Messina, Italy

[37] Harvard Med Sch, Childrens Hosp, Div Epilepsy & Clin Neurophysiol, Dept Neurol, Boston, MA USA

[38] Inst Neurol, Sobell Dept, London, England

[39] Nexstim Ltd, Helsinki, Finland

[40] Copenhagen Hvidovre Univ, Danish Res Ctr Magnet Resonance, Hvidovre, Denmark

[41] Univ Glasgow, Dept Psychol, Ctr Cognit Neuroimaging, Glasgow, Lanark, Scotland

[42] Univ Barcelona, Hosp Clin, Neurol Dept, Barcelona, Spain

[43] UCL, Inst Cognit Neurosci, London, England

[44] Fukushima Med Univ, Sch Med, Dept Neurol, Fukushima, Japan

[45] Weizmann Inst Sci, Dept Neurobiol, Rehovot, Israel

[46] Klinikum Johann Wolfgang Goethe Univ, Frankfurt, Germany

来源：

CLINICAL NEUROPHYSIOLOGY | 2009年 / 120卷 / 12期

基金：

英国生物技术与生命科学研究理事会;

关键词：

Transcranial magnetic stimulation; TMS; rTMs; Safety; THETA-BURST-STIMULATION; HZ REPETITIVE TMS; SOMATOSENSORY-EVOKED POTENTIALS; NONINVASIVE BRAIN-STIMULATION; LONG-TERM-MEMORY; MOTOR CORTEX; PREFRONTAL CORTEX; SINGLE-PULSE; CORTICOSPINAL EXCITABILITY; CORTICAL EXCITABILITY;

D O I：

10.1016/j.clinph.2009.08.016

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

This article is based on a consensus conference, which took place in Certosa di Pontignano, Siena (Italy) on March 7-9, 2008, intended to update the previous safety guidelines for the application of transcranial magnetic stimulation (TMS) in research and clinical settings. Over the past decade the scientific and medical community has had the opportunity to evaluate the safety record of research studies and clinical applications of TMS and repetitive TMS (rTMS). In these years the number of applications of conventional TMS has grown impressively, new paradigms of stimulation have been developed (e.g., patterned repetitive TMS) and technical advances have led to new device designs and to the real-time integration of TMS with electroencephalography (EEG), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI). Thousands of healthy subjects and patients with various neurological and psychiatric diseases have undergone TMS allowing a better assessment of relative risks. The occurrence of seizures (i.e., the most serious TMS-related acute adverse effect) has been extremely rare, with most of the few new cases receiving rTMS exceeding previous guidelines, often in patients under treatment with drugs which potentially lower the seizure threshold. The present updated guidelines review issues of risk and safety of conventional TMS protocols, address the undesired effects and risks of emerging TMS interventions, the applications of TMS in patients with implanted electrodes in the central nervous system, and safety aspects of TMS in neuroimaging environments. We cover recommended limits of stimulation parameters and other important precautions, monitoring of subjects, expertise of the rTMS team, and ethical issues. While all the recommendations here are expert based, they utilize published data to the extent possible. (c) 2009 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

引用

页码：2008 / 2039

页数：32

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