Brain magnetic stimulation for veterans with concussion: Need is high, but evidence is limited

November 05, 2020

November 5, 2020 - Studies using repetitive transcranial magnetic stimulation (rTMS), a noninvasive technique, to help veterans and active-duty service members living with depression, post-traumatic stress disorder (PTSD), and other lasting consequences of concussion have shown promise. However, there's an urgent need for studies designed to address the unique patterns of post-concussion symptoms seen in military populations, concludes a review in the November/December issue of the Journal of Head Trauma Rehabilitation(JHTR). The official journal of the Brain Injury Association of America, JHTR is published in the Lippincott portfolio by Wolters Kluwer.

"rTMS represents a novel innovative, and possibly transformative approach to the treatment of chronic neuropsychiatric and neurocognitive symptoms associated with military concussion," write David L. Brody, MD, PhD, of the Center for Neuroscience and Regenerative Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md., and colleagues. They highlight the need for higher-quality evidence to guide the use of rTMS for service members and veterans with post-concussion symptoms.

rTMS for post-concussive symptoms in veterans: 'Smarter trials' needed

More than 342,000 US service members have experienced concussion over the past two decades. Many of them are living with post-concussive symptoms - especially depression, PTSD, and cognitive issues, often in combination. Despite the high impact of these chronic neuropsychiatric and neurocognitive symptoms, there is a lack of effective, evidence-based treatments.

One potentially useful approach is rTMS, consisting of repeated sessions of noninvasive magnetic stimulation, targeted to specific areas of the brain. Specific rTMS protocols are approved for the treatment of selected patients with major depressive disorder. A growing body of evidence suggests that rTMS may be effective for PTSD and cognitive issues as well.

However, the effectiveness of rTMS for post-concussion symptoms remains unclear; many studies have specifically excluded patients with brain injury or head trauma. In addition, the nature of military concussions and post-concussion symptoms may be very different than in civilian populations.

To assess the current state of knowledge, Dr. Brody and colleagues reviewed the research literature on rTMS for post-concussion symptoms. They identified a total of nine clinical trials, mainly small-scale pilot studies. Evidence for the effectiveness of rTMS for specific types of symptoms was mixed, at best:Based on the results, "there is simply insufficient data" to support the effectiveness of any specific rTMS protocol, Dr. Brody and coauthors write. They do note that rTMS appears safe, and that the negative results in preliminary trials don't necessarily mean that rTMS is ineffective. Key questions remain as to the best stimulation settings and number of sessions, as well as the optimal approach to military and other patients with multiple clinical issues.

"The importance of optimizing feasibility and efficacy of rTMS to treat service members and veterans with chronic neuropsychiatric and neurocognitive symptoms associated with concussion cannot be overstated," Dr. Brody and colleagues conclude. "We need to begin to design smarter trials that are powered to answer research questions to confidently assess and recommend rTMS as a treatment option for this population."
Click here to read "Use of Repetitive Transcranial Magnetic Stimulation in the Treatment of Neuropsychiatric and Neurocognitive Symptoms Associated With Concussion in Military Populations."

DOI: 10.1097/HTR.0000000000000628

About The Journal of Head Trauma Rehabilitation

The Journal of Head Trauma Rehabilitation is a leading, peer-reviewed resource that provides up-to-date information on the clinical management and rehabilitation of persons with traumatic brain injuries. Six issues each year aspire to the vision of "knowledge informing care" and include a wide range of articles, topical issues, commentaries and special features. It is the official journal of the Brain Injury Association of America.

About the Brain Injury Association of America

The Brain Injury Association of America is the country's oldest and largest nationwide brain injury advocacy organization. Our mission is to advance awareness, research, treatment and education and to improve the quality of life for all individuals impacted by brain injury. Through advocacy, we bring help, hope and healing to millions of individuals living with brain injury, their families and the professionals who serve them.

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

Wolters Kluwer reported 2019 annual revenues of €4.6 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning and research and clinical intelligence. For more information about our solutions, visit and follow us on LinkedIn and Twitter @WKHealth.

For more information, visit, follow us on Twitter, Facebook, LinkedIn, and YouTube.

Wolters Kluwer Health

Related Depression Articles from Brightsurf:

Children with social anxiety, maternal history of depression more likely to develop depression
Although researchers have known for decades that depression runs in families, new research from Binghamton University, State University of New York, suggests that children suffering from social anxiety may be at particular risk for depression in the future.

Depression and use of marijuana among US adults
This study examined the association of depression with cannabis use among US adults and the trends for this association from 2005 to 2016.

Maternal depression increases odds of depression in offspring, study shows
Depression in mothers during and after pregnancy increased the odds of depression in offspring during adolescence and adulthood by 70%.

Targeting depression: Researchers ID symptom-specific targets for treatment of depression
For the first time, physician-scientists at Beth Israel Deaconess Medical Center have identified two clusters of depressive symptoms that responded to two distinct neuroanatomical treatment targets in patients who underwent transcranial magnetic brain stimulation (TMS) for treatment of depression.

A biological mechanism for depression
Researchers report that in depressed individuals there are increased amounts of an unmodified structural protein, called tubulin, in lipid rafts compared with non-depressed individuals.

Depression in adults who are overweight or obese
In an analysis of primary care records of 519,513 UK adults who were overweight or obese between 2000-2016 and followed up until 2019, the incidence of new cases of depression was 92 per 10,000 people per year.

Why stress doesn't always cause depression
Rats susceptible to anhedonia, a core symptom of depression, possess more serotonin neurons after being exposed to chronic stress, but the effect can be reversed through amygdala activation, according to new research in JNeurosci.

Which comes first: Smartphone dependency or depression?
New research suggests a person's reliance on his or her smartphone predicts greater loneliness and depressive symptoms, as opposed to the other way around.

Depression breakthrough
Major depressive disorder -- referred to colloquially as the 'black dog' -- has been identified as a genetic cause for 20 distinct diseases, providing vital information to help detect and manage high rates of physical illnesses in people diagnosed with depression.

CPAP provides relief from depression
Researchers have found that continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) can improve depression symptoms in patients suffering from cardiovascular diseases.

Read More: Depression News and Depression Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to