Transient Neuropathic Pain and Sensory Hypersensitivity Following Single-Pulse Transcranial Magnetic Stimulation: A Case Report

TL;DR

A rare case of temporary neuropathic pain and heightened sensitivity occurred after a single low-intensity TMS session in a healthy adult.

Contribution

Highlights a rare adverse effect of single-pulse TMS and effective therapeutic strategies for recovery.

Findings

Transient neuropathic pain and thermal hypersensitivity occurred after low-intensity TMS.

Symptoms improved with pharmacological and non-pharmacological interventions over two months.

MRI showed no structural abnormalities, indicating a functional rather than structural cause.

Abstract

This case report describes a rare instance of transient neuropathic pain and thermal hypersensitivity in a healthy adult following low-intensity single-pulse transcranial magnetic stimulation (TMS). Single-pulse TMS is generally regarded as safe, with only brief and mild sensory effects typically reported. In this case, subtle discomfort in the contralateral hand immediately after stimulation progressed over several days to tingling, warmth, and thermal hyperesthesia. The neurological examination and MRI revealed no structural abnormalities. Symptoms gradually improved with pharmacological treatment using mirogabalin, followed by non-pharmacological interventions, including vibration therapy, transcutaneous electrical nerve stimulation (TENS), and mirror therapy. These interventions provided short-term symptomatic relief and supported functional recovery. Complete resolution occurred within approximately two months. This report highlights that even low-intensity single-pulse TMS can, in rare situations, induce transient neuropathic-like sensory disturbances. Recognizing such presentations may help clinicians provide appropriate reassurance, monitor symptom progression, and apply targeted therapeutic strategies when unexpected sensory effects arise after TMS.

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