Objective: rTMS is increasingly being used for stimulation to non-motor areas, but available safety guidelines are derived from experience with motor cortex rTMS. We reviewed the literature and our own data to assess ...Objective: rTMS is increasingly being used for stimulation to non-motor areas, but available safety guidelines are derived from experience with motor cortex rTMS. We reviewed the literature and our own data to assess the safety of rTMS to non-motor areas. Methods: We reviewed for adverse effects all articles published from January 1998 to December 2003 that applied rTMS to non-motor areas, and analyzed data from our own studies from January 1997 to December 2003. Results: Adverse effects were infrequent and generally mild. Headache was the most common, occurring in 23%of the subjects and more frequent with frontal rTMS. More serious adverse effects were rare and consisted of two seizures and four instances of psychotic symptoms induced by rTMS to the dorsolateral prefrontal cortex in patients with depression. Conclusions: Overall, as currently applied rTMS to non-motor areas appears to be safe with few, generally mild adverse effects. In future studies, we recommend systematic reporting of adverse effects and careful documentation of machine type, coils used, and actual intensity as a function of maximum stimulator output. Phosphene threshold might be used to index stimulati on intensity when rTMS is applied to the visual cortex, and research should be directed to identifying other indexes of intensity for TMS to other non-motor areas. Significance: rTMS under the present guidelines is safe, with minimal adverse effects, when applied to non-motor areas.展开更多
Objectives.- The GRECO study has collected data on pregnancies, regardless of their outcome, that occurred in women taking an oral contraceptive. Patients and methods.-The analysis concerned 551 women prospectively re...Objectives.- The GRECO study has collected data on pregnancies, regardless of their outcome, that occurred in women taking an oral contraceptive. Patients and methods.-The analysis concerned 551 women prospectively recruited in services of gynaecology or obstetrics, termination of pregnancy centres, family planning centres or consultations of gynaecology in France throughout 2002 and who were 12 weeks pregnant or less. Results.-Contraception used during the cycle of conception was an estroprogestative combination in 88% of cases, a microprogestative in 8.7% , a macroprogestative in 0.9% or another type of pill in 2.4% . Progestatives were levonorgestrel 59.0% , gestoden 17.2% , desogestrel 4.7% , norethisterone acetate 2.9% , norgestimate 1.8% , cyproterone acetate 2.0% , norgestrel 1.6% . When asked about the potential cause of the oral contraceptive failure, 76.9% of women reported events such as missed pills which were the most frequent cause of failure (60.8% of failures and 80.1% of events, 2.7 ± 2.7 missed pills), followed by vomiting and diarrhoea. 81.5% of women chose to terminate their pregnancy. Discussion and conclusion.-The GRECO study, despite its limitations (retrospective collection of missed pills data, declaratory data)-showed that missed pills, even once, were the most common reason for oral contraceptive failure. The most frequent decision was the termination of pregnancy.展开更多
文摘Objective: rTMS is increasingly being used for stimulation to non-motor areas, but available safety guidelines are derived from experience with motor cortex rTMS. We reviewed the literature and our own data to assess the safety of rTMS to non-motor areas. Methods: We reviewed for adverse effects all articles published from January 1998 to December 2003 that applied rTMS to non-motor areas, and analyzed data from our own studies from January 1997 to December 2003. Results: Adverse effects were infrequent and generally mild. Headache was the most common, occurring in 23%of the subjects and more frequent with frontal rTMS. More serious adverse effects were rare and consisted of two seizures and four instances of psychotic symptoms induced by rTMS to the dorsolateral prefrontal cortex in patients with depression. Conclusions: Overall, as currently applied rTMS to non-motor areas appears to be safe with few, generally mild adverse effects. In future studies, we recommend systematic reporting of adverse effects and careful documentation of machine type, coils used, and actual intensity as a function of maximum stimulator output. Phosphene threshold might be used to index stimulati on intensity when rTMS is applied to the visual cortex, and research should be directed to identifying other indexes of intensity for TMS to other non-motor areas. Significance: rTMS under the present guidelines is safe, with minimal adverse effects, when applied to non-motor areas.
文摘Objectives.- The GRECO study has collected data on pregnancies, regardless of their outcome, that occurred in women taking an oral contraceptive. Patients and methods.-The analysis concerned 551 women prospectively recruited in services of gynaecology or obstetrics, termination of pregnancy centres, family planning centres or consultations of gynaecology in France throughout 2002 and who were 12 weeks pregnant or less. Results.-Contraception used during the cycle of conception was an estroprogestative combination in 88% of cases, a microprogestative in 8.7% , a macroprogestative in 0.9% or another type of pill in 2.4% . Progestatives were levonorgestrel 59.0% , gestoden 17.2% , desogestrel 4.7% , norethisterone acetate 2.9% , norgestimate 1.8% , cyproterone acetate 2.0% , norgestrel 1.6% . When asked about the potential cause of the oral contraceptive failure, 76.9% of women reported events such as missed pills which were the most frequent cause of failure (60.8% of failures and 80.1% of events, 2.7 ± 2.7 missed pills), followed by vomiting and diarrhoea. 81.5% of women chose to terminate their pregnancy. Discussion and conclusion.-The GRECO study, despite its limitations (retrospective collection of missed pills data, declaratory data)-showed that missed pills, even once, were the most common reason for oral contraceptive failure. The most frequent decision was the termination of pregnancy.
