Transcranial magnetic stimulation: potential treatment for co-occurring alcohol, traumatic brain injury and posttraumatic stress disorders
Open accessAbstract
Alcohol use disorder (AUD), mild traumatic brain injury (mTBI), and posttraumatic stress disorder (PTSD) commonly co-occur (AUD + mTBI + PTSD). These conditions have overlapping symptoms which are, in part, reflective of overlapping neuropathology. These conditions become problematic because their co-occurrence can exacerbate symptoms. Therefore, treatments must be developed that are inclusive to all three conditions. Repetitive transcranial magnetic stimulation (rTMS) is non-invasive and may be an ideal treatment for co-occurring AUD + mTBI + PTSD. There is accumulating evidence on rTMS as a treatment for people with AUD, mTBI, and PTSD each alone. However, there are no published studies to date on rTMS as a treatment for co-occurring AUD + mTBI + PTSD. This review article advances the knowledge base for rTMS as a treatment for AUD + mTBI + PTSD. This review provides background information about these co-occurring conditions as well as rTMS. The existing literature on rTMS as a treatment for people with AUD, TBI, and PTSD each alone is reviewed. Finally, neurobiological findings in support of a theoretical model are discussed to inform TMS as a treatment for co-occurring AUD + mTBI + PTSD. The peer-reviewed literature was identified by targeted literature searches using PubMed and supplemented by cross-referencing the bibliographies of relevant review articles. The existing evidence on rTMS as a treatment for these conditions in isolation, coupled with the overlapping neuropathology and symptomology of these conditions, suggests that rTMS may be well suited for the treatment of these conditions together.
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TMS also improves PTSD symptoms among those with co-occurring mTBI.
“TMS also improves PTSD symptoms among those with co-occurring mTBI [22,27].”
From Frontal Pole Neuromodulation for Impulsivity and Suicidality in Veterans With Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial (2024) · cites this paper as [27]
The “rTMS as a PTSD treatment” section reports improved PTSD symptoms in studies of patients with PTSD, including some with co-occurring depression. But the “Co-occurring conditions” section says the trial involving patients with PTSD, TBI, or both reported no PTSD-specific outcomes. The paper therefore does not establish improvement in PTSD symptoms among people with co-occurring mTBI. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredTMS has demonstrated efficacy in the treatment of PTSD, chronic pain, cognitive deficits, and headaches in individuals with mTBI.
“TMS also has demonstrated efficacy in the treatment of posttraumatic stress disorder (PTSD), chronic pain, cognitive deficits, and headaches in individuals with mTBI [23-27].”
From Frontal Pole Neuromodulation for Impulsivity and Suicidality in Veterans With Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial (2024) · cites this paper as [27]
The ‘rTMS as a PTSD treatment’ section reports studies with improved PTSD symptoms, and the TBI-treatment section describes preliminary evidence of symptom improvement in 15 people with mTBI (page numbers unavailable). It does not establish efficacy for chronic pain, cognitive deficits, or headaches in people with mTBI; it also cautions that TBI treatment evidence is limited. (LLM, conf=0.86)
Experimental — accuracy not yet measured
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Cited by
Sorted by citations
Non-Invasive Brain Stimulation for the Treatment of Symptoms Following Traumatic Brain Injury
Dhaliwal, S. K., Meek, B. P., & Modirrousta, M. (2015) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2015.00119 · Cited by 78 · see citing works
“For example, in a recent review of rTMS as a potential treatment for co-occurring alcohol abuse disorder, TBI, and post-traumatic stress disorder, Herrold and colleagues suggest that high-frequency, supra-threshold rTMS stimulation of the right DLPFC could help promote recovery (78).”
BackgroundPink, A. E., Williams, C., Alderman, N., & Stoffels, M. (2019) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2019.1706585 · Cited by 50 · see citing works
“Herrold et al. (2014) identified seven case studies and one non-randomised pilot study using rTMS to treat a specific neurological sequelae following mTBI.”
BackgroundInfluentialNeuropsychological rehabilitation for traumatic brain injury patients
Chantsoulis, M., Mirski, A., Rasmus, A., Kropotov, J. D., & Pąchalska, M. (2015) · Annals of Agricultural and Environmental Medicine · doi:10.5604/12321966.1152097 · Cited by 20 · see citing works
Spagnolo, P. A., Pérez, L. J. G., Terraneo, A., Gallimberti, L., & Bonci, A. (2018) · European Journal of Neuroscience · doi:10.1111/ejn.14313 · Cited by 16 · see citing works
“…and John Wiley & Sons Ltd European Journal of Neuroscience, 50, 2370–2383 Thus, targeting these regions via rTMS may represent an effective strategy to address core domains shared across different disorders, and characterized by common neural substrates (Herrold et al., 2014; Dunlop et al., 2015).”
BackgroundHerrold, A. A., Sander, A. M., Wilson, K. V., Scimeca, L. M., Cobia, D. J., & Breiter, H. C. (2015) · Current Addiction Reports · doi:10.1007/s40429-015-0078-3 · Cited by 9 · see citing works
Self-citationTang, V. M., Ibrahim, C., Rodak, T., Goud, R., Blumberger, D. M., Voineskos, D., & Foll, B. L. (2023) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2023.105477 · Cited by 11 · see citing works
Lindsey, A., Ellison, R., Herrold, A. A., Aaronson, A., Kletzel, S., Stika, M. M., Guernon, A., & Pape, T. L. B. (2022) · The Journal of Neuropsychiatry and Clinical Neurosciences · doi:10.1176/appi.neuropsych.21090227 · Cited by 12 · see citing works
Self-citationCustomizing TMS Applications in Traumatic Brain Injury Using Neuroimaging
Herrold, A. A., Siddiqi, S., Livengood, S. L., Pape, T., Higgins, J. P., Adamson, M. M., Leung, A., & Raij, T. (2020) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000627 · Cited by 12 · see citing works
Self-citationCheng, P., Zhou, Y., Xu, L., Chen, Y.-F., Hu, R.-L., Zou, Y.-L., Li, Z.-X., Zhang, L., Qi, S., Xun, Y., et al. (2021) · World Journal of Clinical Cases · doi:10.12998/wjcc.v9.i29.8658 · Cited by 7 · see citing works
Repetitive transcranial magnetic stimulation in trauma-related conditions
Namgung, E., Kim, M., & Yoon, S. J. (2019) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s189498 · Cited by 10 · see citing works
“Considering the previously suggested antidepressant effects of rTMS, a growing number of rTMS studies have recently investigated therapeutic efficacy in treatment-resistant PTSD patients with multiple comorbidities.(13) As trauma-exposed individuals with PTSD commonly experience TBI, the neurobiological mechanisms of…”
BackgroundThermal Effects in the Brain During Transcranial Magnetic Stimulation
Sabouni, A., Honrath, M., & Khamechi, M. (2017) · IEEE Magnetics Letters · doi:10.1109/lmag.2017.2759209 · Cited by 6
McNerney, M. W., Gurkoff, G. G., Beard, C., & Berryhill, M. E. (2023) · Brain Sciences · doi:10.3390/brainsci13101402 · Cited by 7 · see citing works
“A decade of theoretical pieces [102–105] and review papers [103,106–110] en-thuse the potential of rTMS to treat the long-term cognitive and psychiatric consequences of TBI with a more tempered set of outcomes. rTMS applies alternating magnetic fields generated from a coil placed on the scalp to…”
BackgroundHerrold, A. A., Smith, B., Aaronson, A. L., Coleman, J., & Pape, T. (2019) · Military Medicine · doi:10.1093/milmed/usy306 · Cited by 4 · see citing works
Self-citationDevelopment of Overlapped Designed Coils for Transcranial Magnetic Stimulations
Bhattacharjee, S., Cho, C., & Dong, S.-C. (2023) · IEEE Magnetics Letters · doi:10.1109/lmag.2023.3295271 · Cited by 4
Gilley, E. (2019) · Journal of Reward Deficiency Syndrome and Addiction Science · doi:10.17756/jrdsas.2019-042 · Cited by 3
“Clients are motivated to increase solution focused behaviors, such as exercise therapy Journal of Reward Deficiency Syndrome and Addiction Science | Volume 5 Issue 1, 2019 3 [28], Transcranial Magnetic Stimulation (TMS) [29], and the taking of nutritional supplements designed to repair, restore and regenerate the addi…”
BackgroundBernanke, A., Hasley, R., Sabetfakhri, N., de Wit, H., Smith, B. M., Wang, L., Brenner, L. A., Hanlon, C., Philip, N. S., Ajilore, O., et al. (2024) · JMIR Research Protocols · doi:10.2196/58206 · Cited by 2 · see citing works
“TMS also has demonstrated efficacy in the treatment of posttraumatic stress disorder (PTSD), chronic pain, cognitive deficits, and headaches in individuals with mTBI [23-27].”
Self-citationA brain-computer interface roadmap for diagnosing and treating neurological disorders
Sun, G., Wang, Y., Liu, H., Weng, L., Li, X., He, W., Sun, J., Liang, S., Kong, W., Dong, J.-Z., et al. (2025) · The Innovation Informatics · doi:10.59717/j.xinn-inform.2025.100016 · Cited by 2 · see citing works
Minute Pulsed Electromagnetic Neurostimulation for Mixed Trauma Syndromes
Nelson, D. V., & Esty, M. (2018) · Journal of Evidence-Based Integrative Medicine · doi:10.1177/2515690x18770136 · Cited by 1 · see citing works
Is transcranial magnetic stimulation useful in posttraumatic disorders?
Paiva, W. S., Neville, I. S., Fregni, F., & Teixeira, M. (2015) · Neural Regeneration Research · doi:10.4103/1673-5374.165529 · Cited by 2 · see citing works
“Herrold et al. (2014) described interventions for alcohol use disorder, mild traumatic brain injury, and posttraumatic stress disorder using rTMS. TMS seems to be a well-suited intervention for the treatment of co-occurring neurological and psychiatric disorders (Bazarian et al., 1999).”
BackgroundMethodInfluentialHerrold, A., Aaronson, A., Bhaumik, D., Durazzo, T. C., Livengood, S., Ramić, A., Riordan, P., Jordan, N., Parrish, T., Mallinson, T., et al. (2024) · JMIR Research Protocols · doi:10.2196/64909
“While we know that some brain regions and networks implicated in AUD alone overlap with mTBI alone and that others are unique to each condition [8], we do not know how co-occurring mTBI affects the AUD brain state to influence function.”
InfluentialSelf-citationStudy of intracranial pressure in human brain during transcranial magnetic stimulation
Honrath, M., & Sabouni, A. (2015) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society · doi:10.1109/embc.2015.7319984
Chronic Traumatic Encephalopathy
Kanthasamy, A. G., Anantharam, V., Jin, H., Ghaisas, S., Zenitsky, G. D., & Kanthasamy, A. (2016) · Springer eBooks · doi:10.1007/978-3-319-44022-4_38 · Cited by 4 · see citing works
Substanzgebundene Abhängigkeitserkrankungen und bulimische Essstörungen
Höppner, J., Kreuzer, P., Wendler, L., Schönfeldt-Lecuona, C., Eichhammer, P., Lefaucheur, J., & Langguth, B. (2015) · Nervenheilkunde · doi:10.1055/s-0038-1627656
- Authors
- Herrold, A., Kletzel, S., Harton, B., Chambers, R., Jordan, N., & Pape, T.-B.
- Affiliations
- Indiana University Indianapolis (US)
- Northwestern University (US)
- ORCID
- Jordan, Neil
- Venue
- Neural Regeneration Research
- Published
- 2014
- Volume
- 9
- Issue
- 19
- Pages
- 1712
- ISSN
- 1673-5374 (ISSN-L)
- PMC
- PMC4238159
- OpenAlex
- W2041614297
- Cited by
- 25
- References
- 173
- Citations by year
- 2025: 3 · 2024: 1 · 2023: 3 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 4 · 2018: 2 · 2017: 1 · 2016: 1 · 2015: 7
- FWCI
- 1.56
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-sa
- Locations
- Neural Regeneration Research (publishedVersion, cc-by-nc-sa)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- IUScholarWorks (Indiana University) (acceptedVersion, cc-by-nc-sa)
- Purdue University Indianapolis (Indiana University) (submittedVersion, cc-by-nc-sa)
- Publisher
- Funders
- U.S. Department of Veterans Affairs (IK2 RX000949)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- repetitive transcranial magnetic stimulation, alcoholism, mild traumatic brain injury, post-traumatic stress disorder, comorbidities, non-invasive brain stimulation, neurobiological model
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