Safety of repetitive transcranial magnetic stimulation in patients with implanted cortical electrodes. An ex-vivo study and report of a case

•Safety of rTMS was assessed ex and in-vivo in a patient with implanted subdural cortical electrodes.•There were no serious adverse effects after the rTMS protocol.•rTMS may be a safe therapeutic tool in patients with implanted subdural cortical electrodes.

ObjectiveTo evaluate the safety of repetitive transcranial magnetic stimulation (rTMS) in patients with implanted subdural cortical electrodes.MethodsWe performed ex-vivo experiments to test the temperature, displacement and current induced in the electrodes with single pulse transcranial magnetic stimulation (TMS) from 10 to 100% of stimulator output and tested a typical rTMS protocol used in a clinical setting. We then used rTMS to the motor cortex to treat a patient with refractory post-herpetic neuralgia who had previously been implanted with a subdural motor cortical electrode for pain management. The rTMS protocol consisted of ten sessions of 2000 stimuli at 20 Hz and 90% of resting motor threshold.ResultsThe ex-vivo study showed an increase in the coil temperature of 2 °C, a maximum induced charge density of 30.4 μC/cm2/phase, and no electrode displacement with TMS. There was no serious adverse effect associated with rTMS treatment of the patient. Cortical tremor was observed in the intervals between trains of stimuli during one treatment session.ConclusionsTMS was safe in a patient with implanted Medtronic Resume II electrode (model 3587A) subdural cortical electrode.SignificanceTMS may be used as a therapeutic, diagnostic or research tool in patients this type of with implanted cortical electrodes.