Repetitive TMS does not improve cognition in patients with TBI

Abstract

ObjectiveTo determine whether high-frequency repetitive transcranial magnetic stimulation (rTMS) improves cognition in patients with severe traumatic brain injury.MethodsA single-center, randomized, double-blind, placebo-controlled study of rTMS was conducted in patients aged 18–60 years with chronic (>12 months postinjury) diffuse axonal injury (DAI). Patients were randomized to either a sham or real group in a 1:1 ratio. A 10-session rTMS protocol was used with 10-Hz stimulation over the left dorsolateral prefrontal cortex (DLPFC). Neuropsychological assessments were performed at 3 time points: at baseline, after the 10th rTMS session, and 90 days after intervention. The primary outcome was change in executive function evaluated using the Trail Making Test Part B.ResultsThirty patients with chronic DAI met the study criteria. Between-group comparisons of performance on TMT Part B at baseline and after the 10th rTMS session did not differ between groups (p = 0.680 and p = 0.341, respectively). No significant differences were observed on other neuropsychological tests. No differences in adverse events between treatment groups were observed.ConclusionsCognitive function in individuals with chronic DAI is not improved by high-frequency rTMS over the left DLPFC, though it appears safe and well-tolerated in this population.ClinicalTrials.gov identifierNCT02167971.Classification of evidenceThis study provides Class II evidence that for individuals with chronic DAI, high-frequency rTMS over the left DLPFC does not significantly improve cognition.

Brain Stimulation in Attention Deficits after Traumatic Brain Injury: A Literature Review and Feasibility Study

“…Only eight papers were published on the impact of NIBS on attention after TBI with abnormal structural imaging in human subjects (7,(17)(18)(19)(20)(21)(22)(23). Four research teams used rTMS (17)(18)(19)23), and four used tDCS (7,(20)(21)(22).…”

“…Only eight papers were published on the impact of NIBS on attention after TBI with abnormal structural imaging in human subjects (7,(17)(18)(19)(20)(21)(22)(23). Four research teams used rTMS (17)(18)(19)23), and four used tDCS (7,(20)(21)(22). Five of the protocols targeted targeted the DLPFC (7,(20)(21)(22)(23), four of which chose the left side (7,(21)(22)(23).…”

“…Four research teams used rTMS (17)(18)(19)23), and four used tDCS (7,(20)(21)(22). Five of the protocols targeted targeted the DLPFC (7,(20)(21)(22)(23), four of which chose the left side (7,(21)(22)(23). Because of the studies' low statistical power, wide variability in type of attention evaluated, study design, lack of consistency between attention type and the tests chosen to assess it, it was di cult to draw a conclusion on NIBS' effectiveness.…”

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

“…Previous studies have shown that high frequency (10-20 Hz) stimulation of the dorsolateral prefrontal cortex (DLPFC) promotes excitatory stimulation (43-46) and can improve anxiety symptoms in patients with neurological disorders (63). Despite initial concerns regarding the use of rTMS on patients with TBI, the safety of this modality has since been demonstrated in this population (64)(65)(66).…”

“…Due to the high incidence of diffuse lesions in moderate to severe TBI and the widespread non-specific brain lesion damage location (9,67,68), this is an excellent population to investigate the efficacy of rTMS intervention on anxiety symptoms. This study is the result of a post-hoc analysis of a clinical trial that evaluated the effects of rTMS on attention and executive functions (66). The current post-hoc analysis aims (1) to investigate the effect of 10 sessions of high frequency rTMS on anxiety symptoms in patients with moderate to severe TBI, (2) to analyze changes in depressive scores, and (3) executive function index after the rTMS between active and control rTMS.…”