Hi,

TMS side effects are uncommon. If complications do occur, they may include:

• mild headaches (most common)
• lightheadedness
• scalp pain
• neck pain
• tingling
• facial twitching
• sleepiness
• altered cognition during treatment

Bhogaraju Anand, Thank you for your response. As a matter of fact, I was asking if it would be okay if a patient received 6 TMS sessions in a week, instead of 5 (usually recommended) sessions a week. My question was about the *frequency* of TMS sessions per week, not really about the side-effects.

Once again, thank you for your time to post your comment.

Regards.

There is no particular added benefit of 6 over 5 sessions and the cost would be high. Duration of treatment is more important. The list of side effects shows they are generally mild, so in case the frequency and duration of exposure is increased the more likelihood of these effects.

Some references:

Lefaucheur JP, Aleman A, Baeken C, Benninger DH, Brunelin J, Di Lazzaro V, Filipović SR, Grefkes C, Hasan A, Hummel FC, Jääskeläinen SK, Langguth B, Leocani L, Londero A, Nardone R, Nguyen JP, Nyffeler T, Oliveira-Maia AJ, Oliviero A, Padberg F, Palm U, Paulus W, Poulet E, Quartarone A, Rachid F, Rektorová I, Rossi S, Sahlsten H, Schecklmann M, Szekely D, Ziemann U. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018). Clin Neurophysiol. 2020 Feb;131(2):474-528. doi: 10.1016/j.clinph.2019.11.002

Yang LL, Zhao D, Kong LL, Sun YQ, Wang ZY, Gao YY, Li N, Lu L, Shi L, Wang XY, Wang YM. High-frequency repetitive transcranial magnetic stimulation (rTMS) improves neurocognitive function in bipolar disorder. J Affect Disord. 2019 Mar 1;246:851-856. doi: 10.1016/j.jad.2018.12.102. Epub 2018 Dec 25. PMID: 30795490.

Buchholtz PE, Ashkanian M, Hjerrild S, Hauptmann LK, Devantier TA, Jensen P, Wissing S, Thorgaard MV, Bjerager L, Lund J, Alrø AJ, Speed MS, Brund RBK, Videbech P. Low-frequency rTMS inhibits the anti-depressive effect of ECT. A pilot study. Acta Neuropsychiatr. 2020 Dec;32(6):328-338. doi: 10.1017/neu.2020.

Chou YH, Ton That V, Sundman M. A systematic review and meta-analysis of rTMS effects on cognitive enhancement in mild cognitive impairment and Alzheimer's disease. Neurobiol Aging. 2020 Feb;86:1-10. doi: 10.1016/j.neurobiolaging.2019.08.020

Kaur M, Michael JA, Fitzgibbon BM, Hoy KE, Fitzgerald PB. Low-frequency rTMS is better tolerated than high-frequency rTMS in healthy people: Empirical evidence from a single session study. J Psychiatr Res. 2019 Jun;113:79-82. doi: 10.1016/j.jpsychires.2019.03.015

Ribeiro JA, Marinho FVC, Rocha K, Magalhães F, Baptista AF, Velasques B, Ribeiro P, Cagy M, Bastos VH, Gupta D, Teixeira S. Low-frequency rTMS in the superior parietal cortex affects the working memory in horizontal axis during the spatial task performance. Neurol Sci. 2018 Mar;39(3):527-532. doi: 10.1007/s10072-017-3243-8.

Lefaucheur JP. Transcranial magnetic stimulation. Handb Clin Neurol. 2019;160:559-580. doi: 10.1016/B978-0-444-64032-1.00037-0

Zhang H, Sollmann N, Castrillón G, Kurcyus K, Meyer B, Zimmer C, Krieg SM. Intranetwork and Internetwork Effects of Navigated Transcranial Magnetic Stimulation Using Low- and High-Frequency Pulse Application to the Dorsolateral Prefrontal Cortex: A Combined rTMS-fMRI Approach. J Clin Neurophysiol. 2020 Mar;37(2):131-139. doi: 10.1097/WNP.0000000000000528