Personalized rTMS in a Perimenopausal Patient With Chronic Insomnia: A Case Report

Background: Chronic insomnia substantially affects quality of life in perimenopausal women, in whom hormonal changes, mood disturbances, and circadian shifts contribute to symptom persistence.Repetitive transcranial magnetic stimulation (rTMS) has shown benefit for insomnia.Personalized rTMS extends this approach by tailoring stimulation protocols using quantitative spectral EEG and psychometric questionnaires.This case report describes EEG-directed personalized rTMS outcomes in a perimenopausal patient with chronic insomnia and comorbid mood symptoms.Methods: A 52-year-old perimenopausal female with a threeyear history of sleep-onset insomnia underwent six weeks of personalized rTMS delivered five days per week.Spectral EEG was obtained at baseline and weekly using a dry-electrode headset to guide protocol adjustments, along with Sleep Condition Indicator (SCI), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) assessments.Stimulation was delivered to FPz, Fz, Cz, F3, and F4.Sessions consisted of 10-20 trains per site (10-15s/train; intertrain interval 10-30s) at frequencies of 10-10.6Hz, with weekly adjustments based on EEG and symptom measures.Results: In this patient, baseline spectral EEG demonstrated slow-wave predominance.At week 6, attenuation of delta and theta activity and increased alpha coherence were observed.SCI scores improved from 6 to 24.GAD-7 scores decreased from 14 to 4, and PHQ-9 scores decreased from 13 to 2.Discussion: Our findings suggest an association between EEGguided personalized rTMS and improvements in sleep and comorbid mood symptoms.The data support the potential of an individualized, multicortical-site neuromodulation approach.Larger studies are required to confirm these observations.These results represent novel, unpublished findings.