Pachalska et al. administered rTMS to a 26-year-old male who had previously (3-5 years) suffered a severe TBI which left him in a coma for 2 months. Brain scans revealed diffuse atrophy and enlarged ventricles in the right hemisphere, and the patient exhibited anosognosia, executive dysfunction, behavioral changes; perseverations, fits of uncontrolled laughter, and was sporadically aggressive and impulsive. Twenty sessions of low-frequency (1 Hz) rTMS were administered over left frontal and temporal regions along with high-frequency (5 Hz) rTMS to right frontal and temporal regions. Following rTMS, the patient showed large improvements in most tests of executive functioning, including: general intelligence, attention, visuospatial ability, and logical memory. He also showed improvement on all categories of the frontal behavioral inventory, including: social conduct, personal conduct, mood disorders, and control disorders. The authors state that the patient had previously shown little progress following "traditional rehabilitation" and only small changes following beta training. Although EEG spectra were no different post-rTMS, NO-GO ERP recordings showed improvement compared to pre-rTMS, though still much different from healthy controls. No seizure events or significant adverse side effects were reported.
Recently, Koski et al. examined the effect of high-frequency rTMS on individuals experiencing post-concussion syndrome (PCS) at least 6 months post-injury. 15 patients with a score of 22 or greater on the PCS Scale received 20 daily sessions of rTMS (10 Hz at 110% resting MT; 20 5 s trains with 25 s ITI; 1000 pulses/session) over the left DLPFC. Two patients quit due to worsening symptoms and one for unrelated reasons. Of the 12 patients who completed treatment, 9 showed an improvement in symptoms (>5 point decrease on PCS scale) and 1 patient worsened. Patients also showed an overall decrease in ratings of headaches, as well as a (statistically uncorrected) decrease in symptoms of fatigue, trouble falling asleep, difficulty remembering, and numbness or tingling. No seizure events or serious side effects were reported. Nine out of twelve patients found 110% MT stimulation to be intolerable in the first session, but all patients tolerated this intensity by the sixth session following gradual intensity increases. fMRI scans demonstrated greater activations in DLPFC and greater deactivation of the rostral ACC during a working memory task following the last session compared to pre-treatment. Results of a 3-month follow-up with some patients indicate that maintenance treatments may be required to sustain the observed gains.