Seizure induced by repetitive transcranial magnetic stimulation for central pain: Adapted guidelines for post-stroke patients.

The patient was a 65-year-old woman who had a righthemispheric ischemic stroke (middle cerebral artery territory, see Fig. 1) in September 2015. The etiology of the stroke is still undetermined to this day. Except for the brain lesion, the patient had no risk factor for epilepsy. She had no previous seizure history even during the acute post-stroke phase, nor did she have a family history of epilepsy. Her daily treatment was composed of: fluoxetin 20mg, atorvastatin 40mg, acetylsalicylic acid 160mg, gabapentin 800mg. She was referred for rTMS because she suffered from pharmacoresistent neuropathic pain in her left arm for a year. Indeed, tramadol, pregabaline, gabapentin, lidocaine patches and transcutaneous electric stimulation had been unsuccessful. Past medical history did not contain any rTMS contraindications and no additional risk factors, i.e. sleep deprivation, change in medication, illegal drug use, or doses of caffeine, were noticed the day of rTMS.