Repetitive Transcranial Magnetic Stimulation
Principal Investigator: Brent E. Masel, M.D.
Purpose of the Study:
The specific aims to be investigated are: Determine if two courses of 1Hz rTMS will produce sustained improvement in motor hand function in individuals with sub-acute traumatic brain injuries (2-12 months) when compared to standard OT treatment and to determine if two courses of 1Hz rTMS will produce any cognitive changes in individuals with sub-acute traumatic brain injuries.
Motor weakness is a common problem following acquired brain injuries such as strokes and traumatic brain injuries (TBI). Unfortunately, in the past several decades, there have been few scientific advancements addressing motor recovery. Whereas high frequency repetitive transcranial stimulation produces an excitatory depolarization of the cortical neurons, low frequency repetitive transcranial stimulation produces cortical neuronal inhibition. Recent studies [1, 2] have suggested a chronic interplay across the corpus callosum of excitatory and inhibitory control, and that inhibition of the non-involved hemisphere may produce transient improvement in the extremity innervated by the involved hemisphere. These studies however have been limited to one course of treatment 1Hz rTMS  and only in chronic strokes. [3, 4]
The central hypothesis is that two courses of low frequency (1Hz) rTMS plus standard OT treatment will produce long lasting motor improvement in hand function following a TBI, and that by applying this modality during the subacute period when the brain is still in a recovery mode, we may affect a significant and sustained improvement. In specific aims 1 and 2, we will determine if two courses of rTMS will produce motoric improvement in subacute stroke, and whether or not it will produce any cognitive changes as well. This study follows a somewhat similar protocol to the Kakuda  and the Fregni  studies previously sited. These subjects, however, will have had a TBI as opposed to a stroke, and will be in the subacute phase (2-10 months) of their injury. The study of 52 days duration will be performed at TLC.