Traumatic brain injuries (TBI) often have lasting impacts on mental health. They can lead to persistent neuropsychiatric symptoms like depression, anxiety, and cognitive decline. People with TBI experience significant emotional and behavioral changes. Changes like these can seriously affect their life.

On the other hand, traditional treatments often fall short. Many are still searching for better solutions. As research grows and results improve, Transcranial Magnetic Stimulation (TMS) is transforming TBI recovery.

What Are Neuropsychiatric Symptoms in Traumatic Brain Injury Patients?

Neuropsychiatric symptoms are a frequent consequence of traumatic brain injury (TBI). These can impact mood, cognition, and overall behavior. Common symptoms include depression, anxiety, mood swings, irritability, and cognitive impairments. Personality changes can also arise. Recovery can be more challenging. 

Studies reveal that 50% of TBI patients experience depression within the first year. Depression and anxiety often appear together. This intensifies emotional struggles and reduces quality of life.

Cognitive impairments also stand out as a major issue. Patients often experience memory problems, attention deficits, and slower processing speeds. Daily functioning, social interactions, and work performance are all affected. Moreover, cognitive impairments are not static. Depending on the individual’s recovery process or other factors, such as stress and fatigue, may worsen or fluctuate. According to research, more than 65% of TBI patients report cognitive deficits that interfere with their ability to function.

Mood swings and irritability are frequent in TBI patients. Damage to brain regions responsible for emotion regulation, such as the frontal lobe, is often the cause. One-third of patients experience increased irritability after a TBI. Irritability can lead to strained personal relationships. Maintaining social connections becomes challenging as a result. Many patients face a heightened risk of social isolation due to these emotional shifts.

Additionally, TBI patients may develop long-term personality changes. This could manifest as increased impulsivity, apathy, or aggressiveness. These changes are often permanent, especially in cases of severe brain injury. As a result, these neuropsychiatric symptoms make TBI not just a physical injury but a mental health crisis for many. 

How Does Transcranial Magnetic Stimulation (TMS) Work?

Transcranial Magnetic Stimulation (TMS) is a non-invasive therapy that stimulates brain cells with magnetic fields. It is known for effectively treating mental disorders. In particular, TMS has shown success in helping those with depression.

• TMS targets specific brain areas associated with mood regulation and cognitive function. The most common target is the prefrontal cortex. It’s a region often disrupted in TBI patients.
• Process starts with placing an electromagnetic coil directly on the scalp. Then, it will send pulses that travel through the skull to reach targeted brain regions. Stimulation helps activate neurons in areas that have reduced function.
• Each session lasts around 30 to 40 minutes. Patients typically undergo 20 to 30 sessions over several weeks.
• The procedure is non-invasive and does not require anesthesia. Patients remain awake and alert during the session. Also, no recovery time is required.
• Side effects are minimal. The most common is mild scalp discomfort or headache, which usually resolves after the session.

Research supports TMS as an effective option for neuropsychiatric disorders. For example, the FDA has approved TMS for depression after multiple clinical trials demonstrated its efficacy. Beyond depression, TMS has shown potential in treating anxiety, PTSD, and cognitive deficits.

What Did the Study on TMS and Neuropsychiatric Symptoms Post-TBI Reveal?

One study looked at using repetitive transcranial magnetic stimulation (rTMS) to treat neuropsychiatric symptoms in a traumatic brain injury (TBI) patient. These symptoms are often debilitating. And standard treatments like medication frequently fail to manage them effectively. The study introduced rTMS as a new option for these patients.

Why Was This Study Conducted?

With conventional treatments being insufficient, researchers wanted to explore whether rTMS could offer a more effective solution. Researchers want to know if a dual-site rTMS protocol could alleviate neuropsychiatric symptoms in a patient who was refractory to standard therapies.

What Was the Treatment Approach?

The patient in the study was a 34-year-old woman with a history of severe head trauma. She struggled with complex neuropsychiatric conditions like obsessive-compulsive behaviors. Impulsivity was also a significant challenge for her.

She had not responded well to medication and other conventional treatments. To address her symptoms, a novel rTMS protocol was applied. It involves 20 daily sessions over a period of several weeks. Here’s what made the treatment unique:

• Dual-site stimulation: The rTMS protocol used two different sites on the brain’s prefrontal cortex. Inhibitory stimulation (1 Hz) was applied to the right dorsolateral prefrontal cortex (DLPFC). Excitatory stimulation (10 Hz) was applied to the left DLPFC.
• Neuronavigation-guided treatment: A neuronavigation system ensured precise targeting during treatment. The DLPFC is essential for mood regulation and cognitive control. That’s why it’s a key focus for neuropsychiatric interventions.
• Alternating stimulation: The combination of inhibitory and excitatory stimulation aimed to restore balance to the brain’s cortico-striato-thalamo-cortical circuits, which are often disrupted in TBI patients.

What Were the Results After Two Weeks?

After just two weeks of daily rTMS sessions, the patient showed significant improvement in some key areas. Notably:

• Reduction in impulsivity: The patient’s impulsivity levels dropped considerably. This is important given the high rate of impulsive behaviors in TBI patients.
• Decrease in obsessive-compulsive symptoms: The study also recorded a reduction in obsessive-compulsive behaviors, an improvement that can be particularly difficult to achieve through conventional treatments alone.
• Improved cognitive function: Enhancements were observed in attention and processing speed, two critical cognitive areas that often deteriorate after a TBI.

These early improvements were promising. rTMS could start providing therapeutic benefits after just a short period of use.

What Happened After Four Weeks?

At the four-week mark, the patient’s impulsivity levels continued to decline. However, there were no further significant changes in the other neuropsychiatric symptoms, such as obsessive-compulsive behaviors or cognitive function. This plateau in improvement may reflect the complex and individualized nature of neuropsychiatric recovery post-TBI. Some symptoms can improve rapidly. Others might require a longer duration or additional interventions for noticeable changes.

The sustained reduction in impulsivity, though, was a significant outcome. Impulsivity often leads to poor decision-making, risk-taking behaviors, and social difficulties. Therefore, maintaining control over this symptom could improve the patient’s overall quality of life and long-term recovery trajectory.

What Were the Long-Term Results at Eight Weeks?

At the eight-week mark, the patient showed lasting positive effects from rTMS treatment. The results were clear and continued afterward. The most noteworthy outcomes included:

• Enhanced positive emotions: The patient reported feeling a stronger sense of well-being. Important for long-term mental health recovery.
• Sustained cognitive improvements: The gains in attention and processing speed seen after just two weeks of treatment lasted through eight weeks. These improvements didn’t fade. And they matter — because better cognition means better daily functioning for the patient.

The study suggests that alternating stimulation of the DLPFC can help modulate activity in critical brain circuits involved in mood regulation and cognition. This is particularly relevant for TBI patients, as their brain circuits are often disrupted due to injury.

Who Is a Good Candidate for TMS After a Traumatic Brain Injury?

Many TBI patients stand to benefit from this treatment. Generally, TMS is often considered for those who haven’t seen results with traditional options. Though evidence suggests TMS may also aid in faster recovery even for those without neuropsychiatric symptoms following a TBI. Early intervention with TMS could help promote a more efficient recovery path.

• Treatment-resistant patients: TMS is most commonly used for patients who do not improve after multiple medication rounds. Up to 50% of individuals with major depressive disorder do not respond to their first antidepressant. So, TMS is a valuable alternative.
• Minimal risk for side effects: Patients who have adverse reactions to medications may prefer TMS because it causes fewer systemic side effects. TMS targets specific brain regions, so its effects are localized.
• Individuals with mood or cognitive disorders: TBI patients with symptoms of depression, anxiety, impulsivity, or cognitive decline may benefit most from TMS. Studies have shown improvements in attention, processing speed, and emotional regulation following TMS therapy.
• Non-surgical preference: TMS is an excellent alternative to more aggressive interventions like ECT or DBS. No hospitalization is required. Patients can return to their daily activities immediately after each session.

It’s important to note that TMS isn’t limited to TBI patients. It’s also a proven treatment for a wide range of mental health disorders, with or without a history of brain injury.

Why Should You Trust the TMS Institute of Arizona for TBI Recovery?

We know TBI recovery requires expert care. Our team has helped countless individuals improve their lives through TMS. Using cutting-edge technology and a compassionate approach, we offer the support you need to address neuropsychiatric symptoms head-on. 

Fewer side effects, non-invasive treatment, and real results.

When others fall short, we deliver. Contact us today.

References

Riccitelli, G. C., Riccardo Borgonovo, Villa, M., Emanuele Pravatà, & Alain Kaelin-Lang. (2024). Efficacy of transcranial magnetic stimulation treatment in reducing neuropsychiatric symptomatology after traumatic brain injury. Frontiers in Neurology, 15. https://doi.org/10.3389/fneur.2024.1412304

‌Hart, T., Brockway, J. A., Fann, J. R., Maiuro, R. D., & Vaccaro, M. J. (2014). Anger self-management in chronic traumatic brain injury: protocol for a psycho-educational treatment with a structurally equivalent control and an evaluation of treatment enactment. Contemporary Clinical Trials, 40, 180–192. https://doi.org/10.1016/j.cct.2014.12.005

‌Rabinowitz, A. R., & Levin, H. S. (2014). Cognitive Sequelae of Traumatic Brain Injury. Psychiatric Clinics of North America, 37(1), 1–11. https://doi.org/10.1016/j.psc.2013.11.004

‌Lavoie, S., Sechrist, S., Quach, N., Reza Ehsanian, Duong, T., Gotlib, I. H., & Isaac, L. (2017). Depression in Men and Women One Year Following Traumatic Brain Injury (TBI): A TBI Model Systems Study. Frontiers in Psychology, 8. https://doi.org/10.3389/fpsyg.2017.00634

‌Howlett, J. R., Nelson, L. D., & Stein, M. B. (2021). Mental Health Consequences of Traumatic Brain Injury. Biological Psychiatry, 91(5), 413–420. https://doi.org/10.1016/j.biopsych.2021.09.024

Disclaimer: This information is for general guidance only and isn’t a substitute for professional medical advice.