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BMJ Case Reports 2018; doi:10.1136/bcr-2018-226698
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)
  • CASE REPORT

Repetitive transcranial magnetic stimulation (rTMS) as a treatment for chronic dizziness following mild traumatic brain injury

  1. Chantel T Debert1,2
  1. 1Department of Clinical Neurosciences, Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary, Alberta, Canada
  2. 2Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Chantel T Debert, chantel.debert{at}ahs.ca
  • Accepted 23 October 2018
  • Published 5 November 2018

Summary

A 61-year-old man sustained a mild traumatic brain injury (mTBI) following a pedestrian versus vehicle traffic accident. Post injury, he began to experience symptoms including light-headedness, spatial disorientation, nausea, fatigue and prominent dizziness brought on by postural change, physical activity or eye movements. Symptoms of dizziness persisted for over 5 years, despite numerous extensive and rigorous vestibular and vision therapy regimens. All investigations suggested normal peripheral and central vestibular functioning. The patient underwent 10 sessions of repetitive transcranial magnetic stimulation (rTMS) treatment, with stimulation of the left dorsolateral prefrontal cortex at 70% of resting motor threshold and a frequency of 10 Hz. Dizziness symptom severity and frequency were reduced by greater than 50% at 3 months post treatment, with a clinically significant reduction of dizziness disability from 40 to 21 points on the Dizziness Handicap Inventory. We propose rTMS as a safe, effective and cost-effective treatment option for patients who experience persistent post-traumatic dizziness secondary to mTBI.

Footnotes

  • Contributors All authors contributed substantially to the concept of the project, data collection, treatment and follow-up of the patient. Specifically, EP was involved in data collection, data analysis and writing of the manuscript. JS was involved in design of the project, data collection, data analysis and reviewing the manuscript. LM aided in developing the project, data collection and data analysis. CTD oversaw the project and was involved in all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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