Neural Noise

rTMS over DLPFC for consciousness recovery in TBI patients

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  • Repetitive TMS (rTMS) over DLPFC can support consciousness recovery in patients with TBI-related disorders of consciousness.1

Weekly enrichment (2026-07-20)

  • A randomized controlled trial (Liu et al., NeuroImage: Clinical 2025; registry ChiCTR2100044930) enrolled 60 patients with disorders of consciousness (DoC); after dropouts, 48 were analyzed — 24 receiving high-frequency rTMS over the DLPFC once per workday for 4 weeks plus conventional awakening therapy, and 24 controls.2
  • In that trial, 17 of 48 patients (35.4%) showed improved level of consciousness on the Coma Recovery Scale-Revised (CRS-R) by Week 4; the median CRS-R change was 2.0 in the rTMS group versus 0.5 in controls.2
  • Nine rTMS patients advanced to a minimally conscious state (MCS) versus three controls, and emergence from MCS (EMCS) was observed exclusively in the rTMS group, including patients initially in VS/UWS.2
  • Resting-state EEG microstate analysis suggested rTMS modulates the balance among cerebral resting-state functional networks, offering a candidate mechanism for consciousness recovery.2
  • A 2025 meta-analysis of randomized controlled trials concluded that DLPFC-targeted rTMS significantly promotes recovery of consciousness in DoC patients, supporting the target across studies.3
  • An earlier meta-analysis (207 patients across seven trials) reported a weighted mean CRS-R improvement of 1.89 (95% CI 1.39–2.39; p<0.00001), with DLPFC stimulation showing a larger effect (WMD 2.24, 95% CI 1.55–2.92) than primary motor cortex, and 20 Hz and ≥20-session protocols performing better.4
  • In a pediatric TBI RCT, 98 children (aged ≥2 years) were randomized to 5 Hz left-DLPFC rTMS (80% resting motor threshold, 1,000 pulses per ~20 min session, once daily for 3 weeks) plus rehabilitation, or rehabilitation alone.5
  • The pediatric rTMS group showed significant gains in CRS-R and Glasgow Coma Scale scores and a significant drop in serum neuron-specific enolase (NSE), with no seizures or adverse events, suggesting combined arousal-promoting and neuroprotective effects.5

Footnotes

  1. https://www.sciencedirect.com/science/article/pii/S1935861X26000172?dgcid=rss_sd_all ↩

  2. https://pmc.ncbi.nlm.nih.gov/articles/PMC12142551/ ↩ ↩2 ↩3 ↩4

  3. https://doi.org/10.1007/s00415-025-13437-x ↩

  4. https://doi.org/10.3390/brainsci13101362 ↩

  5. https://pmc.ncbi.nlm.nih.gov/articles/PMC12554438/ ↩ ↩2

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