A Systematic Review on the Effectiveness of rTMS for Management of Pain, cognitive Dysfunction, and Depression in Traumatic Brain Injury

Aradhana Shukla, Archana Ojha, Anuradha Shenoy, Anil Kumar Gupta
Author(s)
1Assistant Professor, Department of PMR, KGMU, Lucknow, Uttar Pradesh, India. 2Associate Professor, Department of Medicine, MLN Medical college, Prayagraj, Uttar Pradesh, India, 3Assistant Professor, Department of PMR, JIPMER, Pondicherry, India, 4Professor and Head, Department of PMR, KGMU, Lucknow, Uttar Pradesh, India

Abstract

Background: The objective is to evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for improving cognitive dysfunction, pain, and depression following traumatic brain injury (TBI). Material and Methods: A systematic literature search was conducted in PubMed, Scopus, Web of Science, and the Directory of Open Access Journals from database inception to May 2025. Randomized controlled trials evaluating rTMS in patients with TBI were included. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Cochrane Risk of Bias 2 tool. Outcomes of our systematic reviews were cognitive improvement, depression and pain, which were qualitatively compared across studies. Results: Twelve randomized controlled trials involving 305 participants were included, comprising 158 participants receiving active rTMS and 147 receiving sham/control stimulation. Cognitive outcomes were assessed in 5 studies; 1 study demonstrated significant improvement, whereas 4 studies found no significant benefit, indicating heterogeneous cognitive effects. Pain outcomes were evaluated in 5 studies, of which 3 demonstrated significant improvement and 2 showed no statistically significant benefit. Depression was assessed in 7 studies; 2 demonstrated significant improvement, whereas 5 reported no significant between-group benefit. Improvements in some outcomes were observed immediately after treatment, but benefits were not consistently maintained during follow-up. Conclusion: rTMS is a non-invasive neuromodulatory intervention for TBI, however, improvement in cognition, pain and depression following TBI remain inconsistent among studies. Heterogeneity in stimulation parameters, patient characteristics, outcome measures, and follow-up duration limits definitive conclusions. Larger, well-designed multicenter randomized trials with standardized protocols and longer follow-up are warranted.

Keywords: cognitive dysfunction, depression, pain, transcranial magnetic stimulation, traumatic brain injury.

Outline