Editors' ChoiceBrain Trauma

Tackling the Persistent Effects of Concussion

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Science Translational Medicine  24 Sep 2014:
Vol. 6, Issue 255, pp. 255ec165
DOI: 10.1126/scitranslmed.3010413

In some people, the harmful consequences of a concussion can last more than 3 months; there are no effective drugs. Koski et al. hypothesized that repetitive transcranial magnetic stimulation (rTMS)— known to be effective for depression—would be tolerable, safe, and effective in patients with long-lasting symptoms after a concussion.

In this pilot study, 15 patients with persistent mild to severe post-concussive symptoms that lasted 6 or more months received 4 weeks of treatment. In rTMS, magnetic pulses are delivered through the skull to stimulate nerve cells in targeted brain regions. Here the authors administer rTMS on 5 consecutive weekdays (20 sessions), with stimulation intensity increasing gradually across sessions. Subjects completed cognitive testing 2 weeks before and after treatment, and then again 3 months after the last rTMS session.

Among the 12 patients who tolerated all 20 sessions, none reported any serious adverse effects. Two weeks after treatment, the symptoms decreased in 9 of the 12 patients (75%), and overall there was a clinically meaningful mean reduction of post-concussive symptoms. By 3 months after treatment, however, some of the treatment effect had disappeared.

A significant limitation of this study was the lack of a control group; it is unclear whether no treatment would produce similar results. Nevertheless, the results of this study suggest that rTMS treatment for patients with persistent post-concussive symptoms warrants further study.

L. Koski et al., Noninvasive brain stimulation for postconcussion symptoms in mild traumatic brain injury. J. Neurotrauma 10.1089/neu.2014.3449 (2014). [Abstract]

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