Personalized, parcel-guided non-invasive transcranial magnetic stimulation for the treatment of post-concussive syndrome: safety and proof of concept

ABSTRACT

Objective

To determine the safety and proof of concept of a parcel-guided, repetitive Transcranial Magnetic Stimulation (rTMS) in patients who develop a heterogeneous array of symptoms, known collectively as post-concussive syndrome (PCS), following traumatic brain injury (TBI).

Methods

We performed a retrospective review of off-label, individualized, parcel-guided rTMS in 19 patients from December 2020 to May 2023. Patients had at least one instance of mild, moderate, or severe TBI and developed symptoms not present prior to injury. rTMS targets were identified based on machine learning connectomic software using functional connectivity anomaly matrices compared to healthy controls. EuroQol (EQ-5D), as a measurement of quality of life, and additional questionnaires dependent on individual’s symptoms were submitted prior to, after, and during follow-up from rTMS.

Results

Nineteen patients showed improvement in EQ-5D and Rivermead Post Concussion Symptoms Questionnaires − 3 after treatment and follow-up. For nine patients who developed depression, five (55%) attained response and remission based on the Beck Depression Inventory after treatment. Eight of ten patients with anxiety had a clinically significant reduction in Generalized Anxiety Disorder-7 scores during follow-up.

Conclusion

Parcel-guided rTMS is safe and may be effective in reducing PCS symptoms following TBI and should incite further controlled studies.

KEYWORDS:

• Individualized
• functional MRI
• connectomics
• rTMS
• post-concussive disorder

Disclosure statement

Charles Teo and Michael Sughrue are founders and employees of Omniscient Neurotechnology. Jonas Holle is an employee of Cingulum Health. Olivia Lesslar is a consultant of Cingulum Health but is not an employee. Jacky Yeung and Si Jie Tang do not report any conflict of interest.

Ethic statement

This study was approvd by the Human Research Ethics Committee of the South Eastern Sydney Local Health District (2022/ETH00139).

Off-label/Use/Unapproved Drugs or Products

The produce described is currently off-label and is still under investigation for the use described in this report.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/02699052.2024.2371975.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.