Use of Repetitive Transcranial Magnetic Stimulation in the Treatment of Neuropsychiatric and Neurocognitive Symptoms Associated With Concussion in Military Populations.

The review is narrative, not systematic, and lacks a formal risk-of-bias assessment. Most included studies were small pilot trials or case reports with fewer than 15 participants per group, limiting statistical power. There is significant heterogeneity in the populations studied, including differences in injury mechanism (military vs. civilian), time since injury, and comorbidities. rTMS protocols varied widely in target location, frequency, and number of sessions, making direct comparison difficult. No randomized trials have specifically targeted PTSD as a primary outcome in individuals with a history of concussion. The review excludes studies where 80% or more of the cohort did not have a prior concussion, which may limit generalizability to broader TBI populations.

The paper is supported by the U.S. Government, Non-P.H.S. funding. No other specific conflicts of interest are detailed in the provided text.

Do not interpret the mixed positive findings for depression as evidence that rTMS is an established treatment for post-concussion symptoms. The trials were small, often underpowered, and showed no benefit for cognitive deficits, which are a primary concern for many patients.