Transcranial magnetic stimulation (TMS) is a neuro treatment for depression, post-traumatic stress disorder, and obsessive-compulsive disorder. And, researchers are looking at TMS as an alternative treatment for epilepsy.

If you have epilepsy, your brain activity can be abnormal, causing unusual behaviors or sensations, seizures, and loss of awareness. Seizures result from sudden bursts of electrical activity in your brain and can vary from less detectable absence seizures to more severe tonic-clonic, previously called grand mal seizures.

While children can sometimes outgrow their seizure conditions, most people require medications to control them. Approximately one-third of patients with epilepsy have uncontrollable seizures, requiring surgery to curb their abnormal brain activity.

Treating epilepsy with surgery is invasive and comes with many associated risks. Medication has systemic side effects and isn’t always a viable option for women: Most anti-epileptic drugs increase congenital or genetic disability risks, but seizures pose a risk for developing babies in utero.

TMS could be an ideal alternative treatment option as it’s a safe, non-invasive therapy you can have when pregnant. However, brain stimulation comes with specific risks for patients with epilepsy. There is a slight chance TMS can induce seizures. Further research is needed to fully understand the safety and efficacy of TMS to treat epilepsy and to gain FDA approval. Here is what we know:

Seizure Rates Are Similar Whether You Have Epilepsy or Not

If you undergo TMS therapy without preexisting risks for seizures, spontaneous seizures occur in less than <0.001% of cases. However, this risk is no greater than what has been observed with oral antidepressant medications. When patients with epilepsy received TMS treatment for depression, rates varied depending on the study, occurring less than 2.9%. One study had a patient continue their anti-seizure medication and receive treatment for 20 days without seizure induction.

The bottom line is that seizures can occur during TMS, no matter what. Even though the risk is very small, TMS facilities should review their seizure protocol, supportive measures, and proper documentation techniques with their staff. What may appear to be TMS-induced seizures can often have another cause.

Medication Associated Seizures

Specific prescription and over-the-counter (OTC) drugs can lower your body’s seizure threshold. These include:

• Antihistamines widely available OTC
• Opioids such as tramadol
• Antidepressants like bupropion
• Certain anesthetics
• Antibiotics, including penicillins, cephalosporins, and more
• Bronchodilators for breathing issues, such as theophylline or aminophylline
• Antipsychotics such as clozapine or chlorpromazine

Be sure to disclose all medications and herbal remedies you are taking to your practitioner when discussing your TMS plans and your Washington TMS providers during your initial consultation. Most of these medications are studied and safe to use with TMS, but changes to them while undergoing TMS can require your provider to change the placement or intensity of your specific treatment.

Depressant or Stimulant Intake

Stimulants such as cocaine, ecstasy (MDMA), or excessive caffeine intake can trigger seizures. If you routinely consume depressants like alcohol and then stop, the alcohol withdrawal can also induce seizures. Medications like benzodiazepines and gabapentin can be prescribed for other conditions and can be addictive. They also have antiepileptic properties, so if you take them without the supervision of a doctor and stop taking them abruptly instead of tapering your dose, you can also cause seizures.

Sleep Issues

Lack of sleep isn’t a new revelation for triggering seizures, especially for patients with epilepsy. According to Nakken et al. and Ferlisi and Shorvon, sleep deprivation, emotional stress, and fatigue or tiredness are the top three precipitants of seizures. Sleep deprivation can play a role in seizure episodes during TMS. Ensure you are getting plenty of rest before and during TMS treatment.

Because fatigue, stimulants, alcohol, and specific medications can induce seizures, providers should educate you thoroughly about your self-care throughout TMS treatment. Patient education before, during, and after TMS treatment should include the importance of sleep hygiene, continuing consumption of alcohol and caffeine per your standard intake, and not making any medication changes during treatment. If anything does change, report it to your TMS clinician immediately.

Suppose you have experienced seizures and are concerned about your eligibility for TMS. It’s up to the administering provider to determine if your history rules out TMS as a treatment option. If you experience a seizure during TMS, studies show patients can complete treatment without further incidence. Your treatment provider will be your best resource to guide you through what is best in your particular case.

TMS is a game-changing treatment for all sorts of medical issues, and new studies are getting published frequently about what it can do. Hopefully, we will see it approved for treating conditions such as epilepsy shortly. TMS could improve epilepsy treatment options to include safe, non-invasive, and non-systemic therapy that regulates your brain function to reduce seizure activity. Stay current on TMS treatments to be one of the first to receive TMS for your epilepsy.