Table 3:
Clinical Trials investigating the use of rTMS for cognitive symptoms following concussion
| Publication | N (Concussion+Cognitive Symptoms) | Age in Years (Mean, Standard Deviation) | Gender (Male/Female) | Population | Protocol | Number of Sessions, Frequency of Sessions | Blinding | Cognitive Outcome Measure | Reported Effects for Cognitive Outcome Measure | Side-Effects/Adverse Events |
|---|---|---|---|---|---|---|---|---|---|---|
| Koski et al., 2015 Journal of Neurotrauma |
15 | M=34.3, SD=10.8 | 9/6 | Not reported. Academic Medical Center | L-DLPFC (5 cm anterior to M1 scalp targeting): 1000 pulses at 110% MT at 10 Hz, 5 second train duration, 25 second intertrain interval | 20, 1 session/day | Open-Label | Self-report Questionnaire, standardized cognitive tasks | No significant changes in self-report or task performance | headache (n=3), vertigo (n=1), anxiety (n=1), increased sleep/disturbance (n=3) |
|
Leung et al., 2018 Neuromodulation |
29 (14 active, 15 sham) | M=34.1 SD=7.9 | 23/6 | Veteran | L-DLPFC (structural MRI targeting): 2000 pulses at 80% MT at 10 Hz, 10 second train duration, 1 second intertrain interval | 4, 1 session/day | Double Blind | HVLT, Connors CPT-II, Stroop Test | No significant group difference in any cognitive assessments | None Reported |
|
Siddiqi et al., 2019 Journal of Neurotrauma |
14 (9 active, 5 sham) | M=45.5 SD=14.4 | 11/3 | Mixed Sample (2 military) | L-DLPFC (rsfMRI targeting): 4000 pulses at 120% MT at 10 Hz, 5 second train duration, 20 second intertrain interval Followed by R-DLPFC (rsfMRI targeting): 1000 pulses at 120% MT at 1 Hz | 20, 1 session/day | Double Blind | NIH Toolbox | No significant group difference in overall performance on NIH Toolbox Cognitive Battery | Active: transient twitching and discomfort in the facial muscles (n=7), worsening headache (n=1), presyncopal episode (n=1) Sham: worsening headache (n=1) |
|
Hoy et al., 2019 Journal of Neurotrauma |
12 (7 active, 5 sham) | M=45.7 SD=11.4 | Approx. 6/6 (subset of the overall sample) | Not reported, Academic Medical Center | R-DLPFC (structural MRI targeting): 900 pulses at 110% MT at 1 Hz Followed by L-DLPFC (structural MRI targeting): 1500 pulses at 110% MT at 10 Hz, 5 second train duration, 25 second intertrain interval | 20, 1 session/day | Double Blind | Digit span forward and backward, arithmetic, Trail Making A and B, RAVLT, BVMT, Verbal Fluency, Stroop | No significant group difference in any cognitive assessments | Active: 72% Sham: 30% one or more of the following: site discomfort, mild headache, severe headache, both headache and site discomfort |
|
Rao et al., 2019 Journal of Neuropsychiatry & Clinical Neurosciences |
28 (13 active, 15 sham) | M=40.0 SD=14.4 |
Approx. 11/17 (subset of the overall sample) | Not Reported, Academic Medical Center and Department of Defense | R-DLPFC (F4 scalp targeting): 1200 pulses at 110% MT at 1 Hz, 300 second train duration, 60 second intertrain interval | 20, 1 session/day | Double Blind | MOCA, Trail Making A and B, BVMT, HVLT, WCST, Stroop | Only significant group difference was for the BVMT immediate recall measure. All other cognitive assessments showed no significant group difference. | Active: headache (n=Approx. 7), dizziness (n=1), blurred vision (n=1), fatigue (n=1), puffy face (n=1) Sham: headache (n=Approx. 8) |
L-DLPFC=Left Dorsolateral Prefrontal Cortex; cm=centimeters; HVLT=Hopkins Verbal Learning Test; Connors CPT-II=Connors Continuous Performance Test, Second Edition; RVALT=Rey Auditory Verbal Learning Test; BVMT=Brief Visuospatial Memory Test; HVLT=Hopkins Verbal Learning Test; WCST=Wisconsin Card Sorting Test; MRI=Magnetic Resonance Imaging