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Professor Ulf Ziemann,Editor-in-Chief, Clinical Neurophysiology

Professor Ulf Ziemann
Editor-in-Chief, Clinical Neurophysiology

The Editor’s Choice—

Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guideline

Clinical Neurophysiology Volume 132, Issue 1 (January 2021)

Rossi S, Antal A, Bestmann S, Bikson M, Brewer C, Brockmöller J, Carpenter LL, Cincotta M, Chen R, Daskalakis JD, Di Lazzaro V, Fox MD, George MS, Gilbert D, Kimiskidis VK, Koch G, Ilmoniemi RJ, Pascal Lefaucheur J, Leocani L, Lisanby SH, Miniussi C, Padberg F, Pascual-Leone A, Paulus W, Peterchev AV, Quartarone A, Rotenberg A, Rothwell J, Rossini PM, Santarnecchi E, Shafi MM, Siebner HR, Ugawa Y, Wassermann EM, Zangen A, Ziemann U, Hallett M (2021). Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Clin Neurophysiology

The mission of the International Federation of Clinical Neurophysiology (IFCN) is to promote best practice in clinical neurophysiology through education and research. One important route to accomplish this mission is through IFCN-endorsed Expert Guidelines. In this first issue of Clinical Neurophysiology in 2021, a new Guideline is presented by an international group of opinion leaders led by Professor Simone Rossi. The Guideline addresses whether and when Transcranial Magnetic Stimulation (TMS) can be considered safe. The Guideline is based on a consensus conference held Siena (Italy) in October 2018. The Guideline is an update of the more than ten-year-old safety guidelines for the application of TMS in research and clinical settings (Rossi et al., Clinical Neurophysiology 2009; 120:2008-39), the second most highly cited document in the TMS field (3986 citations, Google Scholar). The updated information focuses on topics such as newly developed stimulation devices and pulse configurations, risks of using TMS for magnetic seizure therapy duties and responsibilities of device makers, or minimal training requirements for operators. A critical update on the possible induction of seizures, theoretically the most serious risk of TMS, is provided. It has become apparent that such a risk is low, even in patients taking seizure threshold lowering drugs. The new Expert Guideline is a mandatory read for everybody using diagnostic or therapeutic TMS in humans, and extremely important for regulatory affairs, such as approval of TMS protocols by ethic committees and institutional review boards.

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