The utilization of electroencephalogram and repetitive transcranial magnetic stimulation for case of COVID-19 brain fog

Abstract

Although it is not a medical diagnosis, brain fog composes of sluggish or fuzzy thinking, impaired memory, confusion, and difficulty in focus. In general, this can be caused by stress, sleep disorder, or other illnesses. After the outbreak of COVID-19, an increasing number of patients suffer from COVID-19 brain fog. Since the symptoms of brain fog represent the dysfunction of the brain, electroencephalogram (EEG) plays a role in the evaluation of brain condition due to its convenience. Repetitive transcranial magnetic stimulation (rTMS) has long been a tool to modulate brain function. Here, we demonstrate the EEG changes of a patient with COVID-19 brain fog before and after rTMS. Before rTMS, we measured the EEG of a 29-year-old male who reported impaired memory, difficulty in concentration, and poor working performance after recovery from COVID-19. After the acquisition of EEG, we analyzed it with quantitative EEG (qEEG) methods and calculated the TMS treatment frequency. Then we used rTMS to stimulate the patient over the frontal region with the calculated frequency. After rTMS, EEG was acquired again. Initially, the EEG revealed dominant delta waves and lower alpha band power in the frontal region. After treatments, there was an increase in the power of the alpha band in the frontal region in EEGs. There is a similar finding in coherence. These results indicated that rTMS with calculated frequency could raise the power of the alpha band and the connectivity of brain regions. Clinically, improvement of symptoms was reported by the patient himself. rTMS seems to be one of the modalities to help ameliorate the symptoms of brain fog while EEGs can be a useful tool to evaluate neurological conditions before and after neuromodulation. Keywords: COVID-19, brain fog, qEEG, rTMS, frequency.