TMS Safety Checklist

SAFETY CHECKLIST FOR TRANSCRANIAL MAGNETIC STIMULATION
Patient Identification:
Present condition:
Past medical history:
Current medications:
PATIENT PREFERENCE
Transcranial Magnetic Stimulation has been explained to:
Patient Family Both
The patient and their family would like to proceed with the test: YES NO
The patient and their family would like to know the outcome of the test: YES NO
(Please circle details)
1. At the time of testing 2. At a later time (specify plan) ________________________
Comments:
ABSOLUTE CONTRAINDICATIONS
1. Does the patient have a cochlear implant? YES NO

2. Does the patient have a cortical stimulator? YES NO
3. Does the patient have a deep brain stimulator? YES NO
4. Does the patient have a ventriculoperitoneal shunt? YES NO
5. Does the patient have a skull defect related to their current admission? YES NO
6. Has the patient experienced a prior TMS-related serious adverse event? YES NO
7. Has the patient had a seizure in the last 12 months while taking YES NO
anti-epilepsy medication?
8. Has the patient experienced seizures related to their current admission? YES NO
There can be uncertainty about whether a seizure has occurred, consult a physician if in
doubt
TMS is contraindicated if the answer to any of these questions is YES.
Checklist based on IFCN 2021 Expert Guidelines: Clin Neurophysiol 2021; 132: 269-306
CONSIDERATIONS
For any question with a YES answer, please provide details in the space below. These are not
necessarily contraindications to TMS but discuss with the team physician, for further discussion and
a final decision if needed.
1. Does the patient have a history of epilepsy? YES NO

Consider whether their epilepsy is well-controlled by medication. Anti-epileptic drugs reduce the risk of TMS-related seizure.
Also consider the severity, frequency, and recency of any seizure activity.
Practice notes:
TMS does not result in subclinical EEG abnormalities in healthy adults or patients.
There are two reports of subclinical EEG abnormalities following TMS in people with epilepsy.
The risk of seizure is very low, and estimated to be:
2/100,000 sessions for patients with no history of seizure or epilepsy
27/100,000 sessions for patients with a history of seizure or epilepsy
2. Does the patient have intracranial implants, such as clips or stents, or skull plates? YES NO
If the implant is MRI compatible then it is safe for TMS.
3. Does the patient have any implanted electronics? YES NO

If yes use spacers during TMS testing.
Practice notes:
TMS with figure-8-coils is considered safe in individuals with cardiac pacemakers, vagus nerve stimulation systems, and
spinal cord stimulators if the TMS coil is not activated close to (< 10 cm) electronic components such as the implanted pulse
generator located in the neck or torso. TMS can also be conducted safely in patients with implanted electrodes in the
central and peripheral nervous system that are not connected to a stimulator.
4. Has the patient ever had a skull fracture or brain surgery? YES NO
Burr holes and other openings in the skull do not affect the field generated by TMS.
Practice notes:
Past skull fracture or brain surgery are not absolute contraindications, but ought to be considered by the physician and TMS
operator.
5. Is the patient pregnant? YES NO
Practice notes
Single pulse TMS carries minimal risk in pregnancy. The primary risk to the foetus is a TMS-induced seizure in the mother.
There are 12 published TMS studies that included 50 pregnant people, with no adverse effects on the foetus.
6. Does the patient experience recurring headaches? YES NO

There is a low risk of mild, transient headache after TMS.
This should be communicated to the patient if the answer is YES.
7. Does the patient experience tinnitus or hyperacusis? YES NO

Offer all patients hearing protection, particularly if they answer YES to this question.
TMS operators should also wear hearing protection.
THERAPIST TO COMPLETE
Screening completed by:
Name and role: __________________________________________________________
Signature: _____________________________________ Date: ________________
Additional measures necessary:
Spacers Hearing protection for participant
PHYSICIAN OR REGISTRAR TO COMPLETE

TMS approved for this patient YES NO
If no – reason: _________________________________________________________________________
Name and role: __________________________________________________________
Signature: _____________________________________ Date: ________________

TMS Safety Checklist

Uploaded by

Copyright:

Available Formats

TMS Safety Checklist

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

TMS Safety Checklist

Uploaded by

Copyright:

Available Formats

SAFETY CHECKLIST FOR TRANSCRANIAL MAGNETIC STIMULATION

Past medical history:

1. At the time of testing 2. At a later time (specify plan) ________________________

1. Does the patient have a cochlear implant? YES NO

1. Does the patient have a history of epilepsy? YES NO

3. Does the patient have any implanted electronics? YES NO

6. Does the patient experience recurring headaches? YES NO

7. Does the patient experience tinnitus or hyperacusis? YES NO

Name and role: __________________________________________________________

Signature: _____________________ Date:

Additional measures necessary:

Spacers Hearing protection for participant

PHYSICIAN OR REGISTRAR TO COMPLETE

Name and role: __________________________________________________________

Signature: _____________________ Date:

You might also like