Safety considerations for the use of transcranial magnetic stimulation as treatment for coma recovery in people with severe traumatic brain injury

Sandra L. Kletzel, Alexandra L. Aaronson, Ann Guernon, Christina Carbone, Noor Chaudhry, Elyse Walsh, Mark Conneely, Vijaya Patil, Elliott Roth, Monica Steiner, Marilyn Pacheco, Joshua Rosenow, Theresa L. Bender Pape*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: For persons in states of disordered consciousness (DoC) after severe traumatic brain injury (sTBI), we report cumulative findings from safety examinations, including serious adverse events (AEs) of a repetitive transcranial magnetic stimulation (rTMS) parameter protocol in 2 different studies. Participants: Seven persons in states of DoC after sTBI with widespread neuropathology, but no large lesions in proximity to the site of rTMS. One participant had a ventriculoperitoneal shunt with programmable valve. Methods: Two clinical trials each providing 30 rTMS sessions to the right or left dorsolateral prefrontal cortex, involving 300 to 600 pulses over 1 or 2 sessions daily. One study provided concomitant amantadine. Safety indicators monitored related to sleep, temperature, blood pressure, skin integrity, sweating, weight loss, infections, and seizure. Results: Average changes for monitored indicators were of mild severity, with 75 nonserious AEs and 1 serious AE (seizure). The participant incurring a seizure resumed rTMS while taking antieplieptics without further seizure activity. Conclusions: Considering elevated risks for this patient population and conservative patient selection, findings indicate a relatively safe profile for the specified rTMS protocols; however, potential for seizure induction must be monitored. Future research for this population can be broadened to include patients previously excluded on the basis of profiles raising safety concerns.

Original languageEnglish (US)
Pages (from-to)430-438
Number of pages9
JournalJournal of Head Trauma Rehabilitation
Volume35
Issue number6
DOIs
StatePublished - Nov 2020

Keywords

  • Amantadine
  • Disorders of consciousness
  • Seizure
  • Severe traumatic brain injury
  • Transcranial magnetic stimulation

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation
  • Clinical Neurology

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