Preliminary Observations of Personalized Repetitive Transcranial Magnetic Stimulation (PrTMS ®) for mTBI/Concussion

Background: Repetitive transcranial magnetic stimulation (rTMS) is FDA-approved for major depressive disorder (MDD).While evidence supports good acute response and remission rates with rTMS, long-term outcomes are less reported.This study evaluates rTMS outcomes for up to 1 year.Methods: This retrospective study included patients with MDD who completed at least 20 rTMS sessions using the NeuroStar system between February 2016 and June 2024.Patient Health Questionnaire-9 (PHQ-9) scores were collected at baseline, the end of the 6week acute phase, and at follow-up interval windows of 1, 3, 6, and 12 months.Sustained response (50% reduction in PHQ-9 scores from baseline to the time point of interest) was assessed among acute responders as well as non-responders.Results: A total of 147 patients (mean age 45.6 years, 68% female) were included.The acute response rate was 42.2% (n=62).Sustained response rates among responders at 1, 3, 6, and 12 months were 77% (n=20), 58.6% (n=17), 50% (n=16), and 56.7% (n=17), respectively.Among non-responders (n=85), follow-up response rates were 17.1% (n=7), 10.9% (n=5), 19.6% (n=9), and 23.9% (n=11), respectively.Discussion: Over 50% of rTMS responders sustained their response for up to one year post-treatment, while improvement among non-responders was limited.Identifying factors contributing to sustained response, refining criteria to identify ideal TMS candidates, and optimizing maintenance protocols are critical for improving long-term outcomes.Limitations include reduced follow-up sample sizes and lack of data on subsequent psychiatric treatments received by patients.