The use of repetitive transcranial magnetic stimulation (rTMS) following traumatic brain injury (TBI): A scoping review

Abstract

There is continued interest in developing effective and innovative treatment approaches to manage and improve outcomes after traumatic brain injury (TBI). Included in this, is the potential use of repetitive Transcranial Magnetic Stimulation (rTMS), a neuromodulatory tool currently recommended by the National Institute for Health and Care Excellence as a treatment for depression. This review considers the application of rTMS after TBI, focussing on its therapeutic efficacy for a broad range of sequalae, whether an optimal and safe rTMS protocol can be determined, and recommendations for future clinical and research work. Five research databases (MEDLINE, CINAHL, PsychINFO, SCOPUS, and Web of Science) were electronically searched, identifying thirty empirical studies (single and multiple subject case reports; randomised controlled trials) for full review. Evidence suggest that rTMS has the potential to be an efficacious therapeutic intervention for multiple symptoms after TBI, including depression, dizziness, central pain, and visual neglect. However, the picture is less encouraging for prolonged disorders of consciousness and mixed for cognitive outcomes.Overall, rTMS was well-tolerated by patients, although some incidents of side effects and seizures have been reported. Recommendations are made for more comprehensive guidelines and sufficient reporting of rTMS parameters and procedures.

Effect of Repetitive Transcranial Magnetic Stimulation on Depression and Cognition in Individuals With Traumatic Brain Injury: A Meta-Analysis

“…Yet, anatomic variation between subjects may also have contributed to the heterogeneity of the results. TBI complications vary from patient to patient due to the highly heterogenous nature of the disease with various injury mechanisms 42 . This variability may result from the disruption of different brain networks underlying the mechanism of post-TBI complications.…”

Cortical Electrical Stimulation Ameliorates Traumatic Brain Injury-Induced Sensorimotor and Cognitive Deficits in Rats

“…Repetitive transcranial magnetical stimulation (rTMS) or cortical electrical stimulation (CES) are used as neuromodulatory means for neurological disorders. Recent research suggests that rTMS or CES can alter the neural activities via plasticity-like mechanisms, which have been applied for the treatment of neurological or psychiatric disorders and might have the therapeutic potential for TBI (Gaynes et al, 2014 ; Kamble et al, 2014 ; Sokal et al, 2019 ; Zaninotto et al, 2019 ; Pink et al, 2021 ). However, the results exploring the therapeutic effects of such neuromodulatory tools on TBI are still inconclusive.…”

Transcranial Direct Current Stimulation as a Treatment Tool for Mild Traumatic Brain Injury

“…In particular, TMS measures such as long-interval intracortical inhibition (LICI) and corticomotor silent period (CSP), allows an evaluation of GABA B receptor activity [ 32 ] and recent TMS studies have revealed alterations of these parameters in athletes with recurrent mTBI. Most of these studies found enhanced LICI [ 32 , 34 , 35 , 36 ] and prolonged CSP duration [ 32 , 34 , 36 , 37 , 38 ], indicating increased activity in the GABA B receptor system and intracortical inhibition-excitation imbalance [ 39 ]. In these patients, higher GABA B receptor activity has been coupled with decreased long-term potentiation-like plasticity and motor learning [ 35 ].…”

“…Several reviews of NIBS in moderate-severe TBI have previously been undertaken [ 39 , 59 , 60 , 61 , 62 , 63 ]. Specifically, two groups have reviewed the effects of tDCS on attention, memory, inhibitory control, cognitive flexibility [ 59 , 60 ] and another emphasized the effects on motor impairments [ 61 ].…”