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66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Friendship Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

7. - 10. Juni 2015, Karlsruhe

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Safety of monopulse and repetitive TMS in brain tumor patients and healthy volunteers

Meeting Abstract

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  • Nataliia Kulchytska - Neurochirurgische Klinik, Charité - Universitätmedizin Berlin
  • Yasushi Shin - Nara Medical University
  • Sebastian Ille - Neurochirurgische Klinik, Klinikum rechts der Isar, München
  • Sandro M. Krieg - Neurochirurgische Klinik, Klinikum rechts der Isar, München
  • Peter Vajkoczy - Neurochirurgische Klinik, Charité - Universitätmedizin Berlin
  • Thomas Picht - Neurochirurgische Klinik, Charité - Universitätmedizin Berlin

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocP 119

doi: 10.3205/15dgnc517, urn:nbn:de:0183-15dgnc5177

Veröffentlicht: 2. Juni 2015

© 2015 Kulchytska et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objective: The aim of this study is to report the incidence of typical side effects (pain, syncope, seizures) of navigated transcranial magnetic stimulation (nTMS) in neurosurgical patients and healthy volunteers.

Method: Functional mapping with monopulse nTMS and repetitive nTMS was performed in 638 brain tumor patients (groups 1-3) and 199 healthy volunteers (groups 4, 5).

Group 1 (n=473): monopulse nTMS.

Group 2 (n=58) and group 4 (n=154): repetitive nTMS.

Group 3 (n=107) and group 5 (n=45): monopulse and repetitive nTMS.

52% of the patients (n=330) suffered from symptomatic epilepsy. 59.6% (n=380) tumors were located in the left hemisphere (frontal 51%, parietal 26%, temporal 14.5%, insular 5.2%, internal capsule 3.3%). The histological diagnoses included: 13% glioma II, 15% glioma III, 33% glioma IV, 22% metastases, 4% hemangioma, 3% AVM, 4 meningioma, 6% other. All individuals were questioned about the occurrence of side effects immediately after the examination. Pain intensity was measured using the Visual Analogue Scale (0-10). All patient files were screened for documentation of any delayed effects.

Results: No significant differences were observed in respect to stimulation details between patients and volunteers. An average of 364 stimuli (SD 206; range 20-1215) were applied during monopulse stimulation (645 mappings). The mean intensity was 35% stimulator output and the mean mapping duration 44min. During repetitive TMS (364 mappings) an average of 3131 single pulses were applied (SD 1359; range 785-6470). The mean intensity was 37% stimulator output and the mean mapping duration 75min. The frequencies were distributed as follows: 46% 5Hz; 37%7Hz; 16%10Hz and 1% 20Hz. No adverse events were observed during monopulse nTMS mapping. During repetitive TMS 93.4% of patients and 93.5% of volunteers reported discomfort or pain, while no persisting headache was observed. The mean pain score was 2.5 (0-10) in volunteers and 5.4 (0-9) in patients. No other adverse events were observed as being induced by repetitive TMS.

Conclusions: The results of this study support the concept that monopulse and repetitive nTMS mapping can be considered safe procedures for presurgical work-up in neurosurgical patients. No severe side effects were observed in a large cohort of patients. Stimulation-related discomfort during repetitive nTMS with no persisting pain was observed during the majority of mappings in both volunteers and patients.