An rTMS-induced seizure during low frequency repetitive transcranial magnetic stimulation with a double-cone coil for spasticity: A case report
Abstract
We present a case report of a 51-year-old male after traumatic brain injury (TBI) with cerebral hemorrhage, subsequent involvement of the dominant hemisphere, atrophy of the superior mesencephalon and occipital cortex, manifested by right-sided hemiparesis, aphasia, and a history of depression for which he was on maintenance therapy with vortioxetine (15 mg/d). The patient responded to ten daily LF-rTMS sessions (90% of resting motor threshold; 1200 pulses/session; 1 Hz) over the left primary motor (M1) cortex (corresponding to the somatotopic location of the right thenar) by relieving spasticity in the right hand.
He was subsequently experimentally treated by subthreshold LF-rTMS (90% of resting motor threshold; 1200 pulses/session; 1 Hz) with a double cone coil to relieve right lower limb spasticity. The resting motor threshold for rTMS was determined based on the motor response of the contralateral unaffected (left) toe.
RTMS over the left M1 cortex corresponding to the somatotopic location of the affected (right) leg was administered using a MagPro R30 stimulator with a cool D-B80 coil (Magventure, Inc., Denmark).