Repetitive Transcranial Magnetic Stimulation Combined With Median Nerve Electrical Stimulation for Severe Traumatic Brain Injury.

Combined stimulation showed a promising advantage on the study-defined composite awakening endpoint: 26/28 versus 19/29 and 18/29 with either modality alone.

Wang N, Li M, Zhang G.
Brain and behavior · Publication date: 2026-09-28
Added to site: 2026-10-04
DOI: 10.1002/brb3.71661

Published September 28, 2026 in publisher full text and Crossref; October 2026 is the issue date. Added October 4, 2026.

Modalities

TMS/rTMS, Peripheral stimulation, EEG

Clinical focus

Severe traumatic brain injury, Consciousness recovery

Population

Severe traumatic brain injury with coma, averaging about seven days at entry

Sample

86 randomized: rTMS 29, nerve stimulation 29, combination 28

Intervention / method

Four weeks of left-prefrontal 10-Hz rTMS and/or right median-nerve stimulation, five days weekly

Comparator

Either stimulation modality alone; no sham or standard-care-only group

Clinician summary

GCS favored combination. EEG grading differed from nerve stimulation but not significantly from rTMS. Cognitive testing included only responsive subsets.

How to interpret the findings

The composite endpoint does not mean full recovery. Natural recovery, unblinded treatment and four-week follow-up limit interpretation. Cognitive comparisons have selection bias. No seizures occurred, but hematoma, infection and sympathetic hyperexcitability were reported; safety comparisons were underpowered.

Equipment and disclosures

CCY-I stimulator (Wuhan Yiruide); Nihon Kohden EEG-1200.

Authors report no funding and no competing interests.

Related evidence

Compare findings from the same clinical area, including mixed results.

• Comparative Efficacy of Noninvasive Neuromodulation in Patients with Disorders of Consciousness: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials · Positive with limitations