Low frequency transcranial magnetic stimulation for cognitive recovery after traumatic brain injury: A case report

: Repetitive Transcranial Magnetic Stimulation (rTMS) shows promise for treating sequelae of traumatic brain injury (TBI) including headache and depression. The few studies examining rTMS for cognitive recovery after TBI have reported mixed outcomes. The role of rTMS in cognitive recovery remains unclear. : A 23-year-old woman with persistent executive dysfunction after severe TBI primarily affecting the right prefrontal region underwent 19 sessions of rTMS treatment (2,000 pulses of 1 Hz stimulation delivered to right dorsolateral prefrontal cortex [DLPFC]) 12 months after the injury while continuing cognitive rehabilitation. Response to treatment was evaluated using neuropsychological testing, EEG, and rehabilitation assessments. Significant improvements were observed in basic attention, working memory, processing speed, and executive function. EEG changes were consistent with suppression of pathologic and enhancement of normal neurophysiologic activity in the prefrontal regions. The patient made significantly more progress in rehabilitation in the six months following conclusion of rTMS treatment. : This case demonstrates that low frequency rTMS delivered to right DLPFC can produce significant changes in oscillatory activity and in basic attention, working memory, and executive functioning after TBI, and may enhance rehabilitation outcomes. This case further demonstrates that neuropsychological testing and EEG may be employed to guide rTMS treatment of cognitive deficits following TBI.