Rechallenge following seizure in a patient receiving continuous theta burst stimulation for alcohol dependence
Transcranial Magnetic Stimulation (TMS) is a promising treatment for alcohol dependence, but rare side effects, such as seizures, necessitate careful monitoring. We report the case of a 40-year-old man with alcohol dependence who received sequential bilateral TMS - intermittent theta burst stimulati...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-09-01
|
| Series: | Brain Disorders |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S266645932500085X |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Transcranial Magnetic Stimulation (TMS) is a promising treatment for alcohol dependence, but rare side effects, such as seizures, necessitate careful monitoring. We report the case of a 40-year-old man with alcohol dependence who received sequential bilateral TMS - intermittent theta burst stimulation (iTBS) over the left dorsolateral prefrontal cortex (DLPFC), followed by continuous theta burst stimulation (cTBS) over the right DLPFC alongside Baclofen 120 mg. He experienced a seizure during cTBS targeting the right DLPFC at 100 % of the resting motor threshold (RMT). The seizure occurred during the 22nd session, following recent disulfiram initiation and sleep deprivation. Magnetic resonance imaging and electroencephalogram results were normal. TMS was discontinued, but the patient relapsed on alcohol within five days due to cravings. A carefully considered rechallenge with intermittent theta burst stimulation (iTBS) at 90 % RMT to the left DLPFC was initiated, excluding disulfiram and ensuring adequate sleep before sessions. The patient successfully completed 14 iTBS sessions without recurrence of seizures and achieved six months of abstinence. This case underscores the importance of regular RMT monitoring, cautious dosing, and addressing modifiable risk factors, such as sleep deprivation and medication interactions, to enhance the safety of TMS in clinical practice. A rechallenge with an adjusted TMS protocol can be a viable option after a seizure, offering significant benefits for relapse prevention in alcohol dependence. |
|---|---|
| ISSN: | 2666-4593 |