Int J Clin Exp Med 2018;11(8):7643-7650 www.ijcem.com /ISSN:1940-5901/IJCEM0025977 Review Article How can transcranial magnetic stimulation change the way we treat traumatic brain injury? Iuri S Neville 1,4 , Joyce Gomes-Osman 2,3 , Robson LO Amorim 1,4 , Cintya Y Hayashi 1,4 , Ricardo Galhardoni 4,5 , Ana Luiza Zaninotto 1 , Manoel J Teixeira 1 , Wellingson S Paiva 1,4 1 Neurotrauma Unit at Division of Neurological Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil; 2 Miller School of Medicine at University of Miami, Miami, FL, USA; 3 Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; 4 Brasnet-Brazilian Study Group of Neuromodulation and Neurorestoration after Trauma, University of Sao Paulo Medical School, Sao Paulo, Brazil; 5 School of Medicine, Universidade da Cidade de Sao Paulo (UNICID), Sao Paulo, Brazil Received February 14, 2016; Accepted June 12, 2016; Epub August 15, 2018; Published August 30, 2018 Abstract: Background: Traumatic brain injury (TBI) is a major health and socioeconomic problem worldwide. Despite improvements in the acute management of TBI over the past decades, which has led to better outcomes, there remains a need for novel treatment protocols that facilitate or enhance neuroplasticity and brain repair. There have been an increasing number of scientifc publications describing the use of transcranial magnetic stimulation (TMS) for assessment and treatment in many research settings and clinical conditions, including TBI. Method: This study aimed to identify the role of TMS, a noninvasive brain stimulation technique, in the assessment and treatment of TBI by reviewing articles published to date from the PubMed database. Results: Most published articles on TMS in TBI are case reports. The use of TMS was reported as both a diagnostic tool and therapeutic instrument. There are few controlled trials of TMS in patients with TBI. Conclusion: TMS has the potential to modify the care of patients with TBI. TMS is an important instrument for evaluating brain injury from a functional perspective and also providing insights into neuromodulation approaches that may enhance recovery. Keywords: Brain Injury, noninvasive brain stimulation, rehabilitation, repetitive transcranial magnetic stimulation Introduction Traumatic brain injury (TBI) is a major health and socioeconomic problem worldwide [1-3]. TBI is currently the leading cause of mortality and disability among young adults, and TBI in- cidence has been rising mainly due to incre- ases in motor vehicle use. The World Health Organization (WHO) has estimated that death from road traf fc injuries was the ninth leading cause of death in 2012, and the WHO projects that death from road traf fc injuries will surpass diseases such as diarrheal diseases, HIV/AIDS, and diabetes mellitus to become the ffth lead- ing cause of death worldwide by 2030 [4]. The prognosis following TBI varies from com- plete recovery to death. Many patients experi- ence long-term disabilities. The consequences of TBI include motor, behavioral, and cognitive disabilities, which greatly affect quality of life and work capacity [5, 6]. Cognitive dysfunction remains the leading cause of disability follow- ing TBI [7]. The neuropathophysiology of TBI is complex, involving many pathways that lead to a broad spectrum of lesions. This complexity limits the success of conventional strategies, which are focused on functional recovery. Indeed, most neurosurgical interventions focus on reducing sequelae of the primary brain insult. In ad- dition, all clinical trials that have evaluated pharmacological neuroprotection have failed to prove any beneft [8, 9]. Thus, there is an urgent need for novel approaches to enhance functional recovery following TBI. Materials and methods This study aimed to assess whether TMS, a noninvasive brain stimulation (NBS) technique,