Key Takeaways
- All metabolic patients require cardiovascular assessment before neuromodulation.
- Implanted devices, uncontrolled epilepsy and pregnancy remain absolute TMS contraindications.
- Step-down protocols reduce post-session headache without compromising clinical efficacy.
Pre-treatment screening
Before any session, cardiovascular comorbidities, seizure-threshold-lowering medications and intracranial metal devices must be documented. In patients with elevated BMI, sessions should be adapted for coil positioning and tolerability.
Intra- and post-session monitoring
Blood pressure, heart rate and neurovegetative symptoms should be recorded at baseline, mid-protocol and at cycle completion. Patients with autonomic dysfunction require dedicated medical supervision.
"Safety is not a constraint on research: it is the condition that makes neuromodulation clinically scalable."
— Prof. Elena Rossi, University of Milan
Operational checklist
The BMH Neuromodulation Lab has published a 12-point checklist for TMS, tDCS and taVNS, integrated into workflows at centres enrolled in the Italian metabolic neuromodulation registry.
References
- BMH Consensus Group (2026). Safety standards for neuromodulation in metabolic disease. Brain Stimulation, 19(1), 1–14.
- Oliveira R. et al. (2025). Cardiovascular monitoring during non-invasive brain stimulation: recommendations. Lancet Diabetes Endocrinol, 13(4), 288–296.
Prof. Elena Rossi
Full Professor of Clinical Neuroscience at the University of Milan. Director of the BMH Neuromodulation Lab. Her research focuses on non-invasive brain stimulation for metabolic and psychiatric disorders. She has authored over 80 peer-reviewed publications and led 6 multicentre clinical trials.