Kreuzer et al. report rTMS treatment of severe tinnitus [tinnitus questionnaire (TQ) = 53] persisting for 4 years following a severe TBI in a complex 53-year-old male patient. The patient presented with co-morbid post-injury onset depression and associated severe sleep disorder, alcohol and benzodiazepine abuse, as well as a single symptomatic seizure immediately following injury with no subsequent seizures. Tinnitus symptoms displayed resistance to prior treatments of acupuncture, osteopathy, hyperbaric oxygen therapy, intravenous application of steroids, and acoustic stimulation. Treatment began once alcohol and benzodiazepine intake were excluded via laboratory screening tests administered through the course of rTMS, with antidepressant (75 mg amitriptyline) and antiepileptic (150-300 mg pregabalin) dosage kept constant throughout treatment. Trains of stimulation at 110% resting MT (1 Hz, 2000 stimuli/session) applied to the left primary auditory cortex for 10 sessions demonstrated a positive effect lasting 3 months after the first treatment series (TQ = 38). Four subsequent treatment series over the course of 3 years demonstrated effects lasting 6 months (TQ = 26 after third session, no ratings taken after fourth session). The fifth and final series followed a modified protocol targeted at the right DLPFC (1 Hz, 1000 pulses/session) followed by stimulation applied to the left primary auditory cortex (1 Hz, 1000 pulses/session) for a duration of 5 days (beginning of fifth session TQ = 50; following treatment TQ = 33). The authors state that the patient remained abstinent from alcohol and benzodiazepines throughout treatment. The patient reported a reduction in loudness of tinnitus, and treatment was reported to be well tolerated without adverse effects or seizures as a result of rTMS intervention.