Table S1.
rTMS characteristics and information on seizures
| ID | Patient | Type of TMS | Location | Medication | Sleep hx | Session number | Other risk factors | Outcome of seizure | Type of seizure | Diagnosis | Others |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | F | SP, diagnostic mapping | L-MC | NR | NR | Map (1) | Stroke patient and no hx of seizures | Developed symptomatic poststroke epilepsy | Secondarily GEN | Stroke, left MCA | Epileptiform signs seen on EEG during screening |
| 2 | NR | 10 Hz, 80% MT 2-second stimulation, 58 second-rest-8 session | R-MC | NR | NR | 1 | Stroke patient and no hx of seizures | Secondarily GEN | Stroke, right MCA | Epileptiform signs seen on EEG during screening | |
| 3 | 16 yo F | 10 Hz, 60 trains of 5 seconds, intertrain intervals of 25 seconds and 3,000 stimuli/d; 5 days a week for 4 weeks | L-DLPFC | SRT (150 mg/d), OLZ (75 mg/d), and HDX (24 mg/d) | NR | 12 | 0.20% alcohol concentration on the 12th session | Neurological examination, blood work, and EKG fine | Asymmetric twitching of both arms | MDD | Alcohol complication, outside range of OLZ dosage |
| 4 | 44 yo male | 15 Hz, 110% of motor threshold, 35 pulses/train, 35 trains/session, intertrain interval 26 seconds, 1,225 pulses/d | L-DLPFC | PRX (37.5 mg), DVF (100 mg), and etizolam (2 mg/d) | NR | 4 | Not any known | Showed diffuse, mild cerebral atrophy on MRI | GEN | MDD | Resumed rTMS at subthreshold power level (90% of MT) under sodium valproate coverage |
| 5 | 15 yo F | 20 trains per session with the coil turned on for 4 seconds at a frequency of 10 Hz and MT intensity of 80% and then turned off for 26 seconds (ie, one train lasted 30 seconds in total) | L-PFC | SRT (100 mg/d) | NR | 1 | ECG, EEG, MRI, and blood tests all came back fine during screening | No abnormality in neurological examination; EEG did not indicate any focal lesions or epileptiform discharge, hypomania first night | GEN | Adolescent onset MDD | Sertraline use continued |
| 6 | F | 20 Hz at 120% MT. 42 trains with a 2-second duration for each and a 20-second intertrain interval (total 1,680 pulses/session) | L-PFC | Li (900 mg/d) (blood level of 0.79 mEq/L before entering study) | NR | 12 | No risk factors | No lasting effects determined by cognitive examination | GEN | BD | Limited information on this case |
| 7 | 58 yo M | 10 trains, 10 Hz of rTMS with 2-second duration each train, at 90% of RMT | R-MC | CZX (10 mg at night) for a slight anxiety disorder, acetyl salicylic acid | NR | 1 | Chronic stroke patient, MCA; frequent alcohol use; current withdrawal; and no hx of seizures | Abnormal EEG 1 hour after | Jacksonian | Stroke, MCA | Frequent alcohol consumer, eliminated intake for 2 weeks before |
| 8 | 33 yo M | 50 trains of cTBS at RMT | L-MC | None | Yes | NR | No | MRI, neurological examination and blood tests normal; no EEG done | GEN | Healthy | Recent large time zone change |
| 9 | 30 yo F | 100% MT; constant frequency (20 Hz), duration of each train (2 seconds), ~40 trains, with an intertrain interval of 1 minute | R-PFC | QTP (600 mg/d), DZP (20 mg/d), and GP (150 mg/d) | 9th | No hx of epilepsy and normal MRI | EEG normal | Jacksonian, left arm | BD: type I | Patient decided to go off diazepam for it was made her sleepy. Unknown to staff. Continued treatment when back on diazepam | |
| 10 | 24 yo F | 25 trains per session, intensity of 100% MT, frequency of 10 Hz, 10 seconds turned on and 20 seconds turned off (total of 2,500 pulses/d) | L-MC | NR | NR | 1st | No hx of seizures or other risk factors | Clinical and neurological examinations, blood work, EEG, and CT all normal | GEN | Complex pain regional syndrome | |
| 11 | 35 yo M | Single pulse, 58% delivered the stimulus at the same spot twice 60 seconds apart | R-MC | Li (900 mg/d) and CPZ (50 mg/d) | Yes | 1st | No hx or seizures or risk factors and no hx drugs/alcohol | Found out after brother had one episode of convulsions; EEG showed mostly alpha waves | GEN | BD-current hypomania | Lack of sleep due to hypomania |
| 12 | 45 yo M | 15 Hz, 100% MT, 10-second train, 30-second intertrain | L-DLPFC | NR | Yes | 6th | Healthy | Free of health problem and EEG normal | Grand mal | MDD | Did not sleep over week-end |
| 13 | 28 yo F | Single 2-second train of 20 Hz at 110% MT | MC | FLX (20 mg for anxiety 3 days prior) | NR | 1st | Normal physical and neurological examinations | Neurological examination, MRI, and EEG normal | Secondarily GEN | Possible traumatic brain injury | Fluoxetine was unknown to staff |
| 14 | 36 yo F | Underwent 110% of MT with 20 Hz, 10-second duration and ten trains with an intertrain interval of 60 seconds | L-DLPFC | VFX (112.5 mg/d), TZD (500 mg/d), LOR (3 mg/d), and THR (100 µg/d) | NR | First session of second protocol | Yes. EEG showed mild generalized slowing | EEG recorded bifrontopolar paroxysmal delta activities and abnormal SPECt scan | Frontal lobe complex partial seizure | Mixed depressive ± anxious state; codiagnosed dependent personality, hypothyroidism | Add-on antidepressant strategy. One maprotiline-induced generalized seizure in 1996 |
| 15 | 66 yo F | NR | NR | Secondarily GEN | Hydrocephalus and chronic inflammatory process in CNS | ||||||
| 16 | 26 yo F | 120% MT, 15 Hz, 2.5 seconds, intertrain 120 seconds | MC | None | NR | NR | NR | No lasting effects | Secondarily GEN | Healthy | |
| 17 | 27 yo F | 1%–5%, 15 Hz, three trains ×0.75 seconds, intertrain interval 250 ms | L-PFC | None | NR | 1 | Neurological examination fine | EEG, neurological, pulse, and cognitive tests normal | GEN | Healthy | |
| 18 | 39 yo F | 110%, 25 Hz, four trains ×0.8 seconds, intertrain interval 1 second | MC | None | NR | 1 | Neurological examination fine | EEG, neurological, pulse, cognitive tests normal | GEN | Healthy | |
| 19 | 35 yo F | 10 seconds, frequency 25 Hz, intensity of 2.5× the MEP threshold | L-MC | None | Slept well | Possibly Day 1 | Found out after had a first degree relative with hx of seizures | Neurological examination, EEG, and neuropsychological tests normal. Anxiety about having another seizure | GEN | Healthy | |
| 20 | 62 yo M | Intensity (30%, 40%, and 50% maximum), 51 stimuli given 5–30 seconds apart with a stimulus intensity of 70% | MC | NR | NR | Possibly Day 1 | No hx of seizures and EEG and CT normal | Postictal paresis resolved in 4 days, two further seizures on days 7 and 15 | Jacksonian | Stroke | |
| 21 | 60 yo M | 24 cortical stimuli, <3 Hz | MC | None | NR | After 4 weeks | NR | NR | Jacksonian | Multiple sclerosis | |
| 22 | 30 yo F | 50 cortical stimuli, <3 Hz | MC | None | NR | After 3 weeks | NR | EEG high voltage rhythmic and sharp activities suggest low epileptic threshold | Two GEN same day | Multiple sclerosis | Session before convulsions she had 50 stimuli. This was her fifth series of tests; on four earlier ones over the past 5 months, 40 stimuli had been given |
| 23 | 57 yo M | Single pulse. 40% maximum intensity of stimulator output (2 T pulsed for 100 ns) at intervals of 2 minutes | MC | NR | NR | First | No hx of seizures; EEG and CT demonstrated the MCA infarction | 2 seizures 4 weeks later, seizure free since taking phenytoin (100 mg three times per day) | GEN | Large ischemic scar after MCA infarction | |
| 24 | M | 130% intensity, 3 Hz, 7 seconds, “long” intertrain interval | MC | None | NR | NR | NR | No lasting effects | Partial motor | Healthy | |
| 25 | F | 10-second trains, rTMS, frequency 10 Hz, intensity 0.9× MEP threshold, intertrain interval 1 minute | PFC | AMT and HLD | Several | No lasting effects | Secondarily GEN | Psychotic depression | Investigators were unaware that she was on medications |
Abbreviations: AMT, amitriptyline; BD, bipolar depression; CNS, central nervous system; CPZ, chlorpromazine; cTBS, continuous theta-burst stimulation; CZX, chlordiazepoxide; DLPFC, dorsolateral prefrontal cortex; DVF, desvenlafaxine; DZP, diazepam; F, female; FLX, fluoxetine; GEN, generalized; GP, gabapentin; HDX, hydroxyzine; HF, high frequency; HLD, haloperidol; hx, history; L, left; LF, low frequency; Li, lithium; LOR, lorazepam; M, male; MC, motor cortex; MCA, middle cerebral artery; MDD, major depressive disorder; NR, not reported; OLZ, olanzapine; PFC, prefrontal cortex; PRX, paroxetine; QTP, quetiapine; R, right; rTMS, repetitive transcranial magnetic stimulation; cTBS, continuous theta-burst stimulation; SP, single pulse; SRT, sertraline; THR, thyroxin; TZD, trazodone; VFX, venlafaxine; yo, year old; RMT, resting motor threshold; TMS, transcranial magnetic stimulation; MT, motor threshold; ECG, electrocardiogram; EEG, electroencephalogram; MRI, magnetic resonance imaging; EKG, electrocardiogram; SPECt, single-photon emission computer tomography; MEP, motor evoked potential; CT, computerized tomography.