CASE REPORT article
Front. Psychiatry
Sec. Neurostimulation
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1642846
This article is part of the Research TopicBrain stimulation for cognitive impairments in psychiatric and neurodegenerative disordersView all 7 articles
Bilateral dorsolateral prefrontal cortex high-frequency transcranial magnetic stimulation for consciousness recovery after traumatic brain injury: A case series
Provisionally accepted
- 1Tainan Municipal An Nan Hospital, Tainan City, Taiwan
- 2China Medical University Hospital, Taichung, Taiwan
- 3University of California San Diego, La Jolla, United States
- 4Tzu Chi University, Hualien, Taiwan
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Background: Repetitive transcranial magnetic stimulation (rTMS) is a nonpharmacological intervention that can facilitate consciousness recovery after acquired brain injury. However, the effectiveness of high-frequency rTMS applied bilaterally to the dorsolateral prefrontal cortex (DLPFC) and the utility of single-photon emission computed tomography (SPECT) for monitoring treatment response remain unclear. Methods: Two patients with severe brain injury—one with primary traumatic brain injury and the other with secondary brain injury involving hypoxemic encephalopathy following trauma—received 10 Hz rTMS targeting the bilateral DLPFC (Beam-F3/F4). Each session included 40 trains of 4 seconds with 11-second intertrain intervals, delivered at 100% of the resting motor threshold. Sessions were administered daily, 5 days a week, with 10 sessions per course. Results: Both patients exhibited clinical improvement, with Glasgow Coma Scale scores increasing from 6 to 10 and Coma Recovery Scale–Revised scores increasing from 6 to 16 after 12 courses, indicating a transition from a vegetative state to a minimally conscious state. SPECT revealed reduced hypoperfusion in the bilateral frontal lobes, decreasing from 51% to 40% in Patient A and from 33% to 30% in Patient B. These imaging findings are consistent with the observed clinical improvements. Conclusion: High-frequency rTMS applied bilaterally to the DLPFC may promote consciousness recovery in patients with acquired brain injury, with associated perfusion improvements observed on SPECT. Although these findings are promising, additional controlled studies in larger cohorts are required for validation.
Keywords: Transcranial Magnetic Stimulation, Traumatic Brain Injury, consciousness recovery, DLPFC (dorsolateral prefrontal cortex), bilateral
Received: 07 Jun 2025; Accepted: 10 Sep 2025.
Copyright: © 2025 Chang, Chuang, Leung, Juan, Lee and Tsai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hsin-Chi Tsai, css30bmw@yahoo.com.tw
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