rTMS Safety: Screening, Contraindications and Side Effects

rTMS is well tolerated when patients are carefully selected and protocols follow safety guidelines. A structured screening process is essential for every clinic.

Screening questionnaire essentials

Ask about:

• Metallic objects in or near the head (aneurysm clips, cochlear implants, metal fragments, implanted electrodes).
• Implanted devices (pacemakers, neurostimulators, medication pumps).
• Personal or family history of seizures or epilepsy.
• Head injury, stroke, brain surgery or tumours.
• Medications that lower the seizure threshold.
• Sleep deprivation, alcohol or substance use.
• Pregnancy.

Contraindications

Absolute or strong: ferromagnetic or electronically controlled implants near the coil, such as cochlear implants and some aneurysm clips.

Relative (needing clinical judgement): seizure history, seizure-threshold-lowering drugs, recent alcohol withdrawal, major brain lesions, pacemakers or other implanted devices elsewhere in the body (assess case by case) and pregnancy.

Side effects

• Scalp discomfort or headache. Common and usually mild, and tends to lessen over the course.
• Facial twitching during stimulation.
• Hearing. Coil clicks are loud, so use earplugs.
• Syncope. Occasionally, especially in anxious patients.
• Seizures. Rare; risk is minimised with screening and adherence to stimulation limits.
• Mood switching. Monitor patients with bipolar disorder.

Equipment safety features

Look for coil temperature monitoring, automatic fault detection and dose limits in the protocol library. The MS-50 and MS-100 include these.

Emergency preparedness

• Written seizure management protocol.
• Oxygen, suction and a recovery position plan.
• Staff trained in basic life support.
• Incident documentation.

Documentation

Keep the screening form, consent, motor threshold, session parameters and side effects for every patient.

See also what is rTMS and motor threshold basics.