Center for Neuroscience and Regenerative Medicine, Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland (Dr Oberman); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Ms Exley); Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island (Dr Philip); Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (Dr Siddiqi); Department of Neurosurgery, Stanford School of Medicine, Stanford, and Department of Rehabilitation, VA Palo Alto Healthcare System, Palo Alto, California (Dr Adamson); and Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, and Brain MRI Molecular Contrast Agent Unit, Laboratory of Molecular and Functional Imaging, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland (Dr Brody).
J Head Trauma Rehabil. 2020 Nov/Dec;35(6):388-400. doi: 10.1097/HTR.0000000000000628.
Since the year 2000, over 342 000 military service members have experienced a concussion, often associated with chronic neuropsychiatric and neurocognitive symptoms. Repetitive transcranial magnetic stimulation (rTMS) protocols have been developed for many of these symptoms in the general population.
To conduct a scoping review of the literature on rTMS for neuropsychological and neurocognitive symptoms following concussion.
PubMed and Google Scholar search engines identified 9 articles, written in English, corresponding to the search terms TBI or concussion; and TMS or rTMS; and depression, PTSD, or cognition. Studies that were not therapeutic trials or case reports, did not have neuropsychiatric or neurocognitive primary outcome measures, or described samples where 80% or more of the cohort did not have a TBI were excluded.
There were no reports of seizures nor difference in the frequency or quality of other adverse events as compared with the broader rTMS literature, supporting the safety of rTMS in this population. Support for the efficacy of rTMS for the treatment of neuropsychiatric and neurocognitive symptoms, in this population, is limited.
Large-scale, innovative, neuroscience-informed protocols are recommended to elucidate the potential utility of rTMS for the complex neuropsychiatric and neurocognitive symptoms associated with military concussions.
自 2000 年以来，超过 342000 名军人经历了脑震荡，常伴有慢性神经精神和神经认知症状。针对这些一般人群中的许多症状，已经开发出了重复经颅磁刺激（rTMS）方案。
对 rTMS 治疗脑震荡后神经心理和神经认知症状的文献进行范围综述。
使用 PubMed 和 Google Scholar 搜索引擎，检索了以 TBI 或 concussion 和 TMS 或 rTMS 以及 depression、PTSD 或 cognition 为搜索词的 9 篇英文文章。排除了非治疗性试验或病例报告、没有神经精神或神经认知主要结局测量、或描述 80%或更多队列没有 TBI 的研究。
与更广泛的 rTMS 文献相比，没有报告癫痫发作，也没有其他不良事件的频率或质量差异，支持 rTMS 在该人群中的安全性。rTMS 治疗神经精神和神经认知症状的疗效证据有限。
建议采用大规模、创新性、基于神经科学的方案，阐明 rTMS 治疗与军事性脑震荡相关的复杂神经精神和神经认知症状的潜在效用。
