{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T06:21:29Z","timestamp":1787638889189,"version":"build-2736575974"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Hum. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Traumatic brain injury is frequently followed by persistent executive dysfunction linked to disruption of frontal and frontoparietal networks. High-frequency repetitive transcranial magnetic stimulation (rTMS) targeting the dorsolateral prefrontal cortex (DLPFC) has been proposed as a potential adjunctive intervention to support frontal-network recovery. Still, evidence remains heterogeneous and biomarker-guided interpretation is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective multicenter observational cohort study evaluated adults with traumatic brain injury and persistent executive dysfunction who received standard neurorehabilitation with or without adjunctive high-frequency rTMS. Patients were classified into an rTMS-exposed cohort and a non-rTMS comparison cohort according to documented treatment exposure. Primary outcomes were changes in Frontal Assessment Battery (FAB) and MoCA executive-domain scores. Secondary outcomes included Glasgow Outcome Scale\u2013Extended and Trail-Making Test A\/B performance. Multimodal biomarkers included TMS-EEG N100\/P200 amplitudes, fNIRS task-evoked left DLPFC oxyhemoglobin (HbO2) response, and resting-state fMRI DLPFC\u2013frontoparietal connectivity. Adjusted regression analyses were performed to estimate associations between documented rTMS exposure and study outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty-eight patients were included, with 24 in the rTMS-exposed cohort and 24 in the non-rTMS comparison cohort. Documented rTMS exposure was associated with greater improvement in FAB score at post-treatment assessment (+3.1 points; 95% CI, 1.6 to 4.6;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and MoCA executive-domain score (+2.8 points; 95% CI, 1.3 to 4.3;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.001). Functional recovery and Trail-Making Test performance also favored the rTMS-exposed cohort. Biomarker analyses showed greater N100\/P200 modulation, increased left DLPFC HbO response, and stronger DLPFC\u2013frontoparietal connectivity. Observed biomarker changes were correlated with executive-function improvement; however, these associations should be interpreted as exploratory and hypothesis-generating given the observational design and limited sample size. Adverse events were mild, with no documented seizures or serious adverse events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>High-frequency left-DLPFC rTMS exposure was associated with improved executive recovery and measurable frontal-network modulation after traumatic brain injury. These findings suggest that multimodal neurophysiological and imaging biomarkers may provide useful measures of target engagement for future prospective studies. Given the retrospective observational design, modest sample size, and short-term follow-up, causal inferences regarding treatment effects or biomarker-guided neurorehabilitation cannot be established.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnhum.2026.1900612","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:34:34Z","timestamp":1787636074000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Advanced imaging\u2013integrated rTMS therapy for frontal network recovery after traumatic brain injury"],"prefix":"10.3389","volume":"20","author":[{"given":"Nan","family":"Hu","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiling","family":"Chen","sequence":"additional","affiliation":[{"name":"Fuzong Clinical Medical College of Fujian Medical University","place":["Fuzhou, China"]},{"name":"Department of Neurosurgery, The 900th Hospital of the People's Liberation Army Joint Logistics Support Force","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiante","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anorectal Surgery, The Second Affiliated Hospital and Yuying Children\u2019s Hospital of Wenzhou, Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Zheng","sequence":"additional","affiliation":[{"name":"Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People\u2019s Hospital, Affiliated People\u2019s Hospital, Hangzhou Medical College","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"175","DOI":"10.25259\/SNI_926_2024","article-title":"Use of repetitive transcranial magnetic stimulation in traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials","volume":"16","author":"Aleid","year":"2025","journal-title":"Surg. 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