Repetitive Transcranial Magnetic Stimulation in Adolescents With Persistent Postconcussion Symptoms After Mild Traumatic Brain Injury: An Open Label Safety and Feasibility Study

Abstract

BACKGROUND: Although most children and adolescents with a mild traumatic brain injury recover quickly, a significant minority develop intractable headaches, cognitive difficulties, and/or mood disturbances known as persistent postconcussion symptoms (PPCS). Repetitive transcranial magnetic stimulation (rTMS) offers significant therapeutic potential in PPCS. METHODS: Fourteen adolescents (15.6 ± 1.5 years, 10 females) with PPCS ≥3 months postinjury (median: 4, 3-16 months) were recruited into an open label, single centre, safety/feasibility rTMS trial. Four weeks of once daily rTMS (20 visits, 10 Hz at 120% of resting motor threshold, 3000 stimulations per session) was applied to the left dorsolateral prefrontal cortex. Adverse events were monitored at every treatment. Additional outcomes included the Post-Concussion Symptom Inventory (PCSI) and Pediatric Quality of Life Inventory (PedsQL). RESULTS: No serious adverse events were observed. Headaches were the most frequent adverse event; but headaches tended to decrease in frequency over the treatment course. Twelve out of 14 participants attended 90% or more of the rTMS sessions. After 4 weeks of rTMS, PCSI total scores decreased from pre-rTMS values by 27.5 ± 20.9 points (Z = -3.3, P < 0.001) and PedsQL total scores increased by 12 ± 12.6 points (t(13) = -3.5, P = 0.004). One-month post-rTMS, PedsQL scores were still increased but PCSI scores were not different from baseline. CONCLUSIONS: High frequency rTMS to the left dorsolateral prefrontal cortex is safe/feasible for adolescents with PPCS. Results provide data to inform large randomized, sham-controlled trials to explore the efficacy of rTMS to treat pediatric PPCS.