Research Reports - Noninvasive brain stimulation for persistent postconcussion symptoms in mild traumatic brain injury

J Neurotrauma. 2014 Jun 23

Koski L(1), Kolivakis T, Yu C, Chen JK, Delaney S, Ptito A

Mild traumatic brain injury (mTBI) is typically followed by various
post-concussive symptoms (PCS), including headache, depression, and cognitive
deficits. In 15-25% of cases, PCS persists beyond the usual 3-month recovery
period, interfering with activities of daily living and responding poorly to
pharmacotherapy. We tested the safety, tolerability and efficacy of repetitive
transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal
cortex (DLPFC) for alleviating PCS. Fifteen eligible patients with mTBI and PCS
>3 months post-injury consented to 20 sessions of rTMS (20 x 5-sec trains; 10-Hz
at 110% threshold), with clinical and functional magnetic resonance imaging
(fMRI) assessments before and after intervention, and clinical assessment at
3-month follow-up.. Primary outcomes were tolerability, safety, and efficacy as
measured with the PCS Scale. Secondary outcomes included Cognitive Symptoms
Questionnaire, neuropsychological test performance, and working memory
task-associated activity as assessed with fMRI. Twelve patients completed all
sessions. Three withdrew due to worsening symptoms or for an unrelated event.
Stimulation intensity was increased gradually across sessions and all subjects
tolerated the protocol by the sixth session. Commonly reported side-effects among
completers were increased headache (n=3) and greater sleep disturbance (n=3).
Participants also reported positive outcomes such as less sleep disturbance
(n=3), and better mental focus (n=3). On average, PCS scores declined by 14.6
points (p = 0.009) and fMRI task-related activation peaks in the DLPFC increased
following rTMS. rTMS is safe, tolerated by most patients with mTBI, and
associated with both a reduction in severity of PCS and an increase in
task-related activations in DLPFC. Assessment of this intervention in a
randomized control trial is warranted.

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