Transcranial low-frequency pulsating electromagnetic fields (T-PEMF) as post-concussion syndrome treatment
A small but significant number of mild traumatic brain injuries (mTBI) result in development of persistent prolonged symptoms, including cognitive deficits, headaches, and mental fatigue. Such symptoms are called post-concussion syndrome (PCS), usually diagnosed according to the International Classification of Disease (ICD)-10 or the Diagnostic and Statistical Manual of Mental Disorder (DSM)-IV. However, the concept of PCS as one unique syndrome is debated, and it remains unclear clear why and who develops PCS.
The majority of studies use the term PCS to describe persistent concussion symptoms over 3 months following a non-penetrating direct or indirect blow to the head accompanied by loss of consciousness or alterations in mental state for <30 minutes. Current management of PCS consists of a multidisciplinary approach of pharmaceutical treatment, vestibular and vision rehabilitation, cognitive behavioral therapy and physical therapy. A meta-analysis from 2018 of PCS intervention, however, found evidence of concussion treatment limited. Treatment with low-frequency pulsating electromagnetic fields (PEMF) is a non-invasive, self-administered method best known from treatment of non-union long bone fractures where accelerated bone healing process has been well-established. Low-frequency electromagnetic field therapy has since evolved to include transcranial application based on in vitro and experimental in vivo findings of neuroprotective effects including cell proliferation and differentiation, enhanced neurite outgrowth, reduced apoptosis, increased angiogenesis, and increased microvascular perfusion and tissue oxygenation.
Compliance was high as all subject completed the full treatment. Two patients however experienced a worsening of their concussion symptoms during the course of treatment. The remaining patients had some discomfort in relation to treatment, mainly headache, but passing and less for each treatment. The majority (n = 5) had a reduction in symptoms overall, up to 61% (2%-61%) based on the Rivermead Post-Concussion Symptoms Questionnaire. Further studies on T-PEMF as a treatment option for post-concussion syndrome are warranted.
Miller CP, Prener M, Dissing S, Paulson OB. Transcranial low-frequency pulsating electromagnetic fields (T-PEMF) as post-concussion syndrome treatment. Acta Neurol Scand. 2020;142:597–604. https://doi.org/10.1111/ane.13300