Use of repetitive transcranial magnetic stimulation in traumatic brain injury: A systematic review and meta-analysis of randomized controlled trials.

Background: Traumatic brain injury (TBI) is an injury resulting from external force exerted directly or indirectly on the skull. This is presently the major cause of mortality and disability among youth globally. Repetitive transcranial magnetic stimulation (rTMS) was proposed for the treatment of various neurological disorders such as TBI. We conducted the current systematic review and meta-analysis to investigate the efficacy of rTMS in TBI patients.

Methods: We conducted our database searching on PubMed, Scopus, and Web of Science from inception till August 2024 to look for articles that fulfil our aim. The search strategy was based on two main keywords: "Transcranial magnetic stimulation" AND "Traumatic brain injury." We conducted the pooled analysis of continuous variables using standardized mean difference (SMD) due to difference in measurement scales.

Results: Seven randomized controlled trials were included. A statistically significant improvement in cognitive function was observed after rTMS compared to control group with SMD of 0.7 (95% confidence interval [CI]: 0.25, 1.14, P = 0.002) with non-significant heterogeneity, and pain with SMD of -0.57 (95% CI: -1.02, -0.11, P = 0.01), I² = 64%, P = 0.04. However, no difference was observed between the two groups regarding depression with SMD of -0.1 (95% CI: -0.54, 0.35, P = 0.67).

Conclusion: The use of rTMS is associated with improved cognitive functions and reduction in pain. No effect was observed regarding depression but future studies are still warranted in this important clinical field.