Use of Repetitive Transcranial Magnetic Stimulation in the Treatment of Neuropsychiatric and Neurocognitive Symptoms Associated With Concussion in Military Populations

Abstract

Background: Since the year 2000, over 342 000 military service members have experienced a concussion, often associated with chronic neuropsychiatric and neurocognitive symptoms. Repetitive transcranial magnetic stimulation (rTMS) protocols have been developed for many of these symptoms in the general population. Objective: To conduct a scoping review of the literature on rTMS for neuropsychological and neurocognitive symptoms following concussion. Methods: PubMed and Google Scholar search engines identified 9 articles, written in English, corresponding to the search terms TBI or concussion; and TMS or rTMS; and depression, PTSD, or cognition. Studies that were not therapeutic trials or case reports, did not have neuropsychiatric or neurocognitive primary outcome measures, or described samples where 80% or more of the cohort did not have a TBI were excluded. Results: There were no reports of seizures nor difference in the frequency or quality of other adverse events as compared with the broader rTMS literature, supporting the safety of rTMS in this population. Support for the efficacy of rTMS for the treatment of neuropsychiatric and neurocognitive symptoms, in this population, is limited. Conclusions: Large-scale, innovative, neuroscience-informed protocols are recommended to elucidate the potential utility of rTMS for the complex neuropsychiatric and neurocognitive symptoms associated with military concussions.

Memantine inhibits cortical spreading depolarization and improves neurovascular function following repetitive traumatic brain injury

“…There remains an outstanding need for clinically applicable CSD-directed therapies that may be used across the TBI severity spectrum. This includes therapies applicable for use in sporting athletes and military service people, given the high incidence of mild TBI among both populations ( 16 , 71 ). However, whether CSDs are common in humans with mild TBI has not been demonstrated to date.…”

Neurostimulation for Traumatic Brain Injury: Emerging Innovation

“…At low frequency, rTMS enables cortical inhibition, perhaps by induced suppression of parvalbumin and calbindin, whereas high frequency rTMS (3-50 Hz) enables targeted excitation of the lesioned cortex, benefiting stroke patients, though the latter finding remains debated in the literature [30][31][32]. Moreover, emerging data purports that TMS can be safely delivered to infants with perinatal brain damage (N = 6) and in persons with cooccurring TBI and complex neuropsychiatric comorbidities [33][34][35]. Still, further research is needed to establish the safety and scoping efficacy of high-frequency rTMS in seizure-prone (or otherwise compromised) patient populations.…”

Non-invasive brain stimulation and neuroenhancement

“…Military organizations have been interested in NIBS for some time for its possible therapeutic use in treating diseases and injuries typical of military occupations ( Oberman et al, 2020 ), but they have also recognized the usefulness, even the need, to explore cognitive enhancement for national security ( Malish, 2017 ). It has been pointed out that with advancing technology, the modern soldier requires more complex mental skills than in the past, but that cognitive performance degrades in combat situations, and that NIBS may provide the means to counteract that degradation ( Davis and Smith, 2019 ).…”