Title : Rewiring recovery: Effect of repetitive transcranial magnetic stimulation on neuropsychological outcomes following mild to moderate traumatic brain injury
Abstract:
Background: Traumatic brain injury (TBI) remains a major global public health concern and a leading cause of long-term cognitive, behavioural, and psychological disability, particularly among the productive age population. Neuropsychological impairments following TBI are frequently associated with disruption of fronto-cortical networks and underlying white matter tract injury. Repetitive transcranial magnetic stimulation (rTMS) has recently emerged as a promising non-invasive neuromodulatory strategy for enhancing functional recovery in neurorehabilitation.
Objectives: To evaluate clinico-radiological correlation and neuropsychological outcomes in patients with mild to moderate TBI, with special emphasis on white matter tract injury, and to assess the therapeutic efficacy of rTMS.
Methods: This prospective cohort study was conducted over three years at AIIMS Raebareli under the Departments of Neurosurgery, Psychiatry, and Radiodiagnosis. Adult patients with mild to moderate TBI (GCS >10) underwent MRI brain with Diffusion Tensor Imaging (DTI) and were categorized based on white matter tract deviation and cerebral edema. Neuropsychological evaluation was performed using the Montreal Cognitive Assessment (MOCA) and Hamilton Depression Rating Scale (HDRS) at baseline and follow-up. Patients demonstrating persistent neuropsychological deficits received high-frequency rTMS (10 Hz) over the right or left dorsolateral prefrontal cortex at 110% of individual resting motor threshold across 10 sessions over 5 days. Follow-up assessments were conducted at 3, 6, and 12 months.
Results: A total of 60 patients (40 males and 20 females; mean age 36.24 years) were included in the analysis. Mean resting motor threshold declined from 75.35% at baseline to 70.61% at follow-up, with corresponding reduction in stimulation intensity from 82.81% to 77.84%, suggesting improved cortical responsiveness. Mean MOCA scores increased from 19.22 to 23.82 following intervention, demonstrating significant cognitive improvement. Mean HDRS scores decreased from 5.56 to 4.70, indicating improvement in depressive symptoms and psychological well-being.
Conclusion: rTMS demonstrated sustained improvement in cortical excitability, cognitive outcomes, and psychological recovery among patients with mild to moderate TBI, particularly in individuals with white matter tract involvement. These findings support rTMS as a safe, non-invasive, and clinically effective adjunct to multidisciplinary TBI management and highlight its translational potential in contemporary neurorehabilitation practice.
