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Seizure in a Nonpredisposed Individual Induced by Single-Pulse Transcranial Magnetic Stimulation

Kratz, Oliver MD*; Studer, Petra MSc*; Barth, Wolfgang MD*; Wangler, Susanne MD*; Hoegl, Thomas MSc*; Heinrich, Hartmut PhD*†; Moll, Gunther H. MD*

doi: 10.1097/YCT.0b013e3181d2ef85
Case Reports

Seizure induction is a rare, but serious adverse effect of the otherwise very safe method of transcranial magnetic stimulation (TMS). There are only very few single case reports concerning seizure in single-pulse TMS. All of these reports describe individuals with neurological disorders or epileptogenic medication.

To our knowledge, we are the first to describe a healthy subject who developed symptoms of a seizure after single-pulse TMS during motor threshold estimation.

This case report provides evidence that single-pulse TMS may provoke a seizure even in the absence of neurological risk factors. Differential diagnoses of a classic neurological seizure, that is, convulsive syncope and psychogenic seizure, are discussed.

Neurogenic seizure after TMS and convulsive syncope are the most probable hypotheses, although clear specification of this singular incident remains impossible.

Therefore, to minimize the risk for such rare adverse effects, existing and new suggestions are combined to provide reasonable precautions to be taken before and during TMS application.

From the *Department of Child and Adolescent Mental Health, University of Erlangen-Nürnberg, Erlangen; and †Heckscher-Klinik München, Munich, Germany.

Received for publication November 4, 2009; accepted January 4, 2010.

Reprints: Oliver Kratz, MD, Department of Child and Adolescent Mental Health, University of Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen, Germany (e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.