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Multidisciplinary Rehabilitation in Combination with Repetitive Transcranial Magnetic Stimulation in a Patient with Apathy Following Traumatic Brain Injury: A Case Report

Takuya Hada and Masahiro Abo

Currently, few reports are available on rehabilitation treatment combined with repetitive transcranial magnetic stimulation (rTMS) in patients with higher brain dysfunctions. Here, we report the case of a patient with apathy following traumatic brain injury, who underwent rehabilitation in combination with rTMS.

The patient is a 31-year-old woman who was diagnosed with higher brain dysfunction with symptoms of apathy and attentional deficit based on clinical symptoms and neuropsychological examinations. Single-photon emission computed tomography (SPECT) revealed decreased blood flow in the medial frontal lobe.

The patient was hospitalized for two weeks of inpatient treatment. Low-frequency rTMS was applied over the right dorsolateral prefrontal cortex (DLPFC) and administered at 90% of minimum motor threshold for the upper limb motor area, 1 Hz, for 40 minutes once daily (2,400 pulses per day) excluding Sunday, and a total of 12 rTMS treatments were implemented.

In addition, a physiotherapist and an occupational therapist provided rehabilitation treatment. The treatment outcomes were classified using the Apathy Evaluation Scale, Clinical Assessment of Attention Deficit (CAT), and SPECT. The easy Z-score Imaging System (eZIS), fine stereotactic regions of interest template (FineSRT), and three-dimensional stereotactic region of interest template (3DSRT) were used to analyze SPECT images.

The patient completed the two weeks of multidisciplinary rehabilitation treatment in combination with rTMS without the occurrence of adverse events, and achieved improvements in the Apathy Evaluation Scale, CAT score, and blood flow in the medial frontal lobe, angular gyrus, head of caudate nuclei, and posterior cingulate gyrus in SPECT images.

We successfully treated a patient with apathy following traumatic brain injury with multidisciplinary rehabilitation treatment combined with rTMS, and confirmed the safety and efficacy of this treatment approach. SPECT scans confirmed improvement in cerebral blood flow.