The Effects of Repetitive Transcranial Magnetic Stimulation on Anxiety in Patients With Moderate to Severe Traumatic Brain Injury: A Post-hoc Analysis of a Randomized Clinical Trial

Abstract

Background: Traumatic brain injury (TBI) is one of the leading causes of neuropsychiatric disorders in young adults. Repetitive Transcranial Magnetic Stimulation (rTMS) has been shown to improve psychiatric symptoms in other neurologic disorders, such as focal epilepsy, Parkinson's disease, and fibromyalgia. However, the efficacy of rTMS as a treatment for anxiety in persons with TBI has never been investigated. This exploratory post-hoc analyzes the effects of rTMS on anxiety, depression and executive function in participants with moderate to severe chronic TBI.Methods: Thirty-six participants with moderate to severe TBI and anxiety symptoms were randomly assigned to an active or sham rTMS condition in a 1:1 ratio. A 10-session protocol was used with 10-Hz rTMS stimulation over the left dorsolateral prefrontal cortex (DLPFC) for 20 min each session, a total of 2,000 pulses were applied at each daily session (40 stimuli/train, 50 trains). Anxiety symptoms; depression and executive function were analyzed at baseline, after the last rTMS session, and 90 days post intervention.Results: Twenty-seven participants completed the entire protocol and were included in the post-hoc analysis. Statistical analysis showed no interaction of group and time (p > 0.05) on anxiety scores. Both groups improved depressive and executive functions over time, without time and group interaction (ps < 0.05). No adverse effects were reported in either intervention group.Conclusion: rTMS did not improve anxiety symptoms following high frequency rTMS in persons with moderate to severe TBI.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02167971.

The Rehabilitation Potential of Neurostimulation for Mild Traumatic Brain Injury in Animal and Human Studies

“…Another opportunity involves researching and optimizing stimulation parameters for those with mood disorders experiencing cognitive deficits due to mTBI and an adjacent study testing patients with moderate/severe TBI, e.g., [241][242][243][244][245]. Although the focus of this review was solely on cognition, hmTBI is highly comorbid with anxiety or depressive disorders, especially within the Veteran community [246].…”

Repetitive Transcranial Magnetic Stimulation for Neuropathic Pain and Neuropsychiatric Symptoms in Traumatic Brain Injury: A Systematic Review and Meta-Analysis

“…Twelve RCTs were ultimately selected for systematic review from 1605 records with a total of 276 TBI patients [7,10,[35][36][37][38][39][40][41][42][43][44][45], and 11 of them with 236 patients were included in the meta-analysis [7,[35][36][37][38][39][40][41][42][43]45], as shown in Figure 1.…”

“…Transcranial magnetic stimulation (TMS) is a noninvasive, painless interventional method that induces nerve cell activity in superficial areas of the sensory-motor circuits and facilitates plastic changes in neural networks [ 4 , 5 ]. Repeated application of TMS at regular intervals, also called repetitive TMS (rTMS), is a tool to enhance clinical recovery in both mild [ 6 , 7 ] and more severe TBI patients [ 8 – 10 ]. rTMS treatment acts through an electromagnetic field created by a coil placed on the scalp [ 11 ], generating a superficial cortical current that is capable of changing neuron activity, even in brain regions that are distant from the stimulation site.…”