FERİDE GÖKBEN HIZLI SAYAR, OĞUZ TAN, Gül ERYILMAZ, EYLEM ÖZTEN, Celal ŞALÇİNİ, KAŞİF NEVZAT TARHAN

Transkraniyal manyetik uyarım tedavisi sırasında ortaya çıkan nöbet

Transkraniyal manyetik uyarım (TMU) tekniği, gerek serebral korteks işlevlerinin lokalizasyonunu belirlemeyi amaçlayan nörofizyolojik araştırmalarda, gerekse sinir sistemi hastalıklarının tedavisini hedefleyen klinik çalışma- larda kullanılır. TMU beyin dokusunun uyarımını sağlayan, invazif olmayan bir tekniktir. Sinir sisteminin belli bir bölgesine ayarlanabilir bir şiddette ve frekansta, bir defa veya çok sayıda manyetik atım verilmesinden oluşur. TMU'nun klinik uygulamaya girdiği 1985 yılından bu yana en fazla çalışma depresyon hastaları üzerine yapılmış- tır. Klinik çalışmaların çoğu, TMU'nun depresyon tedavisinde etkili olduğunu göstermektedir. TMU farmakolojik tedavilere yanıt vermeyen dirençli depresyonda da uygulanmış ve yalancı (sham) TMU'ya üstün bulunmuştur. Beynin her iki hemisferinin çeşitli bölgeleri farklı parametreler kullanılarak uyarılmıştır, ama araştırmalara katılan depresyon hastalarının %90'ına sol dorsolateral prefrontal kortekse yüksek frekanslı ve tekrarlayan uyarımlar verilmiştir. Yüksek frekanslı ve tekrarlayan TMU'nun en ciddi yan etkisinin, oldukça nadir görülmekle birlikte nöbet olduğu bildirilmektedir. Bu yazıda tekrarlayan TMU (tTMU) uygulaması sırasında jeneralize tonik-klonik nöbet geçiren bir olgu sunulmakta ve TMU ile indüklenen nöbet üzerine literatür gözden geçirilmektedir.

Seizure in a patient receiving transcranial magnetic stimulation treatment

Transcranial magnetic stimulation (TMS), a non-invasive technique that enables the stimulation of the brain tissue, has been used not only in neurophysiological research aimed at localizing cortical functions but also in the treatment of nervous disorders. It includes administration of single or repetitive magnetive pulses of adjustable intensity and frequency to a certain part of the nervous system. Depression is the leading illness on which the most robust data have been increasingly collected since the introduction of TMS into clinical use in 1985. Many clinical studies have demonstrated that TMS is effective in the treatment of depression. TMS has also been used in depressive patients resistant to pharmachological intervention and found to have higher efficacy compared with sham TMS. Although various parts of the both hemispheres have been stimulated by employing different parame- ters, 90 percent of depressive patients included in clinical studies have received repetitive stimulations of high fre- quency to dorsolateral prefrontal cortex. It has been reported that the most serious side effect of repetitive and high-frequency TMS is the occurence of seizures. We present a case who had a generalized tonic-clonic seizure during TMS treatment and literature on TMS-induced seizure is reviewed.

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