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Abstract：
OBJECTIVE: When considering repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder, clinicians often face a lack of detailed information on potential interactions between rTMS and pharmacotherapy. This is particularly relevant to patients receiving bupropion, a commonly prescribed antidepressant with lower risk of sexual side effects or weight increase, which has been associated with increased risk of seizure in particular populations. Our aim was to systematically review the information on seizures occurred with rTMS to identify the potential risk factors with attention to concurrent medications, particularly bupropion.
METHODS: We conducted a systematic review through the databases PubMed, PsycINFO, and EMBASE between 1980 and June 2015. Additional articles were found using reference lists of relevant articles. Reporting of data follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
METHODS: Two reviewers independently screened articles reporting the occurrence of seizures during rTMS. Articles reporting seizures in epilepsy during rTMS were excluded. A total of 25 rTMS-induced seizures were included in the final review.
METHODS: Data were systematically extracted, and the authors of the applicable studies were contacted when appropriate to provide more detail about the seizure incidents.
RESULTS: Twenty-five seizures were identified. Potential risk factors emerged such as sleep deprivation, polypharmacy, and neurological insult. High-frequency-rTMS was involved in a percentage of the seizures. None of these seizures reported had patients taking bupropion in the literature review. One rTMS-induced seizure was reported from the Food and Drug Administration in a sleep-deprived patient who was concurrently taking bupropion, sertraline, and amphetamine.
CONCLUSIONS: During the consent process, potential risk factors for an rTMS-induced seizure should be carefully screened for and discussed. Data do not support considering concurrent bupropion treatment as contraindication to undergo rTMS.
METHODS: We conducted a systematic review through the databases PubMed, PsycINFO, and EMBASE between 1980 and June 2015. Additional articles were found using reference lists of relevant articles. Reporting of data follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
METHODS: Two reviewers independently screened articles reporting the occurrence of seizures during rTMS. Articles reporting seizures in epilepsy during rTMS were excluded. A total of 25 rTMS-induced seizures were included in the final review.
METHODS: Data were systematically extracted, and the authors of the applicable studies were contacted when appropriate to provide more detail about the seizure incidents.
RESULTS: Twenty-five seizures were identified. Potential risk factors emerged such as sleep deprivation, polypharmacy, and neurological insult. High-frequency-rTMS was involved in a percentage of the seizures. None of these seizures reported had patients taking bupropion in the literature review. One rTMS-induced seizure was reported from the Food and Drug Administration in a sleep-deprived patient who was concurrently taking bupropion, sertraline, and amphetamine.
CONCLUSIONS: During the consent process, potential risk factors for an rTMS-induced seizure should be carefully screened for and discussed. Data do not support considering concurrent bupropion treatment as contraindication to undergo rTMS.
摘要：
目的：在考虑重性抑郁症的重复经颅磁刺激（rTMS）时，临床医生经常面临缺乏关于rTMS与药物治疗之间潜在相互作用的详细信息.这与接受安非他酮的患者特别相关，一种常用的抗抑郁药，具有较低的性副作用或体重增加的风险，这与特定人群的癫痫发作风险增加有关。我们的目的是系统地审查与rTMS发生的癫痫发作的信息，以确定潜在的危险因素，并注意并发药物。尤其是安非他酮。
方法：我们通过PubMed数据库进行了系统综述，PsycINFO,和EMBASE在1980年至2015年6月之间。使用相关文章的参考列表找到了其他文章。数据报告遵循系统审查和荟萃分析声明的首选报告项目。
方法：两名评审员独立筛选了报告rTMS期间癫痫发作发生的文章。报道rTMS期间癫痫发作的文章被排除。最终审查共纳入25例rTMS诱发的癫痫发作。
方法：系统地提取数据，我们在适当时联系了适用研究的作者,以提供有关癫痫发作事件的更多细节.
结果：确定了25次癫痫发作。潜在的危险因素出现了，如睡眠不足，多药，和神经上的侮辱.一定比例的癫痫发作涉及高频rTMS。在文献综述中，这些癫痫发作均未报告患者服用安非他酮。美国食品和药物管理局报告了一名同时服用安非他酮的睡眠不足患者的一次rTMS诱发的癫痫发作，舍曲林,和安非他明.
结论：在同意过程中，应仔细筛选和讨论rTMS诱发癫痫的潜在危险因素.数据不支持将同时使用安非他酮治疗视为进行rTMS的禁忌症。
方法：我们通过PubMed数据库进行了系统综述，PsycINFO,和EMBASE在1980年至2015年6月之间。使用相关文章的参考列表找到了其他文章。数据报告遵循系统审查和荟萃分析声明的首选报告项目。
方法：两名评审员独立筛选了报告rTMS期间癫痫发作发生的文章。报道rTMS期间癫痫发作的文章被排除。最终审查共纳入25例rTMS诱发的癫痫发作。
方法：系统地提取数据，我们在适当时联系了适用研究的作者,以提供有关癫痫发作事件的更多细节.
结果：确定了25次癫痫发作。潜在的危险因素出现了，如睡眠不足，多药，和神经上的侮辱.一定比例的癫痫发作涉及高频rTMS。在文献综述中，这些癫痫发作均未报告患者服用安非他酮。美国食品和药物管理局报告了一名同时服用安非他酮的睡眠不足患者的一次rTMS诱发的癫痫发作，舍曲林,和安非他明.
结论：在同意过程中，应仔细筛选和讨论rTMS诱发癫痫的潜在危险因素.数据不支持将同时使用安非他酮治疗视为进行rTMS的禁忌症。
