Search Results (319)

Background/Objectives: Transcranial magnetic stimulation (TMS) initiates a cascade from intracranial electric-field exposure through neural recruitment and plasticity to distributed network responses. Neuronavigation improves the geometric reproducibility of delivery but does not guarantee equivalent cortical exposure or target engagement. This narrative review integrates these levels within an operational framework for precision TMS. Methods: Six domain-specific PubMed searches covering 1 January 1985 to 31 July 2026 were supplemented by Google Scholar and citation tracking. A documented rerun on 17 August 2026 yielded 6430 records (5617 unique after cross-query deduplication). Evidence was synthesized narratively; no quantitative synthesis or formal risk-of-bias assessment was performed. Results: Neuronavigation improves geometric precision by stabilizing target definition and coil pose, whereas individualized electric-field models estimate intracranial exposure. Neither establishes biological precision, which also depends on neuronal orientation, brain state, circuit architecture, medication, and behavior. Motor-system measures are not validated as universal biomarkers for nonmotor cortex, and no single validated biomarker captures TMS-induced plasticity. Convergent, controlled multimodal evidence may strengthen inference about target engagement; adaptive and closed-loop approaches remain experimental. Conclusions: Geometric delivery, modeled exposure, biological engagement, and durable functional or clinical benefit require separate validation. Spatial accuracy alone does not establish clinical value. Full article

Background: Long COVID has emerged as a global health challenge characterized by persistent neuropsychiatric symptoms, including depression, fatigue, and cognitive impairment. Growing evidence indicates that sustained neuroinflammation, endothelial dysfunction, and fronto-limbic network disruption may underlie these symptoms, representing pathophysiological features distinct from major depressive disorder (MDD). Although repetitive transcranial magnetic stimulation (rTMS) is an established treatment for MDD, its therapeutic efficacy in Long COVID-associated depression remains uncertain. Methods: Long COVID was defined as laboratory-confirmed SARS-CoV-2 infection followed by persistent neuropsychiatric symptoms lasting ≥3 months, including cognitive impairment (“brain fog”), fatigue, and new-onset depressive symptoms. We conducted a retrospective registry-based cohort study using real-world clinical data from two TMS clinics in Tokyo (May 2022–April 2026). Forty-four medication-free patients with Long COVID-associated MDD were compared with eighty-eight propensity score–matched patients with primary MDD (1:2 nearest-neighbor matching based on age, sex, and baseline Montgomery–Åsberg Depression Rating Scale (MADRS)). All participants received left dorsolateral prefrontal cortex intermittent theta burst stimulation (iTBS). Treatment outcomes were evaluated using MADRS and 17-item Hamilton Depression Rating Scale (HAM-D₁₇) improvement rates, HAM-D₁₇ response, and remission. Statistically adjusted analyses (inverse probability of treatment weighting (IPTW) and doubly robust estimation) were used to reduce measured confounding; however, residual unmeasured confounding cannot be excluded due to the retrospective observational design. Results: Long COVID patients showed significantly attenuated antidepressant response. Improvement rates were markedly lower for MADRS (38.4% vs. 61.5%) and HAM-D₁₇ (36.7% vs. 58.4%). IPTW and doubly robust models demonstrated large adjusted percentage-point differences (MADRS: −23.0 percentage points; HAM-D₁₇: −21.8 percentage points; both p < 0.001). While HAM-D₁₇ response did not differ significantly, remission rates were substantially reduced (27.3% vs. 61.4%). Conclusions: These findings indicate an adjusted association suggesting reduced rTMS responsiveness in Long COVID-associated depression. Given the retrospective observational design and the possibility of residual unmeasured confounding, the results should be interpreted as associations rather than evidence of a causal effect. Full article

Background and Clinical Significance: Parkinson’s disease (PD) is a progressive neurodegenerative disorder for which nonpharmacological neuromodulatory approaches are being explored as adjunctive strategies. Deep transcranial magnetic stimulation (dTMS) using an H-coil can engage broader and deeper cortical networks than conventional focal coils, although anatomically distant structures are expected to be influenced through network modulation rather than direct electromagnetic stimulation. Case Presentation: We describe a five-patient exploratory case series evaluating clinical measures and cerebral perfusion before and three months after high-frequency dTMS targeting the supplementary motor area (SMA). Clinical outcomes included the Unified Parkinson’s Disease Rating Scale (UPDRS) Parts I-IV, Non-Motor Symptoms Scale (NMSS), Hoehn–Yahr stage, and Timed Up and Go test. Antiparkinsonian medication regimens and doses remained unchanged during the three-month follow-up. Cerebral perfusion was assessed using single-photon emission computed tomography (SPECT) and statistical parametric mapping. No clinical outcome reached nominal statistical significance at follow-up; given the sample size, this should be interpreted as limited statistical power rather than evidence of no effect. At an exploratory voxel-wise threshold of p < 0.001, uncorrected, SPECT identified a 28-voxel cluster of increased regional cerebral blood flow in the right cerebellar cortex (peak MNI coordinates: 22, −38, −44; t = 5.96; z = 3.11). Conclusions: These observations are hypothesis-generating and may reflect network-level modulation of SMA–cerebellar circuitry. Because only five patients were included, no sham-controlled arm was available, and the imaging analysis used an uncorrected exploratory threshold, causal or efficacy claims cannot be made. Larger sham-controlled studies with standardized dose-to-imaging timing, formal neuropsychological assessment, individualized targeting, and prespecified corrected imaging analyses are warranted. Full article

Background/Objectives: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulatory approach with potential therapeutic value for cognitive impairment in Alzheimer’s disease (AD). Ferroptosis-related oxidative injury has been implicated in AD-associated neuronal dysfunction, but whether rTMS-induced functional improvement is accompanied by changes in ferroptosis-related oxidative injury remains unclear. This study evaluated the effects of high-frequency rTMS on cognitive function, hippocampal neuronal excitability, and ferroptosis-related oxidative injury in amyloid precursor protein/presenilin-1 (APP/PS1) mice, using Ferrostatin-1 (Fer-1) as a pharmacological comparator. Methods: Six-month-old female mice were used, including age-matched C57BL/6J controls and APP/PS1 mice assigned to the AD + Sham, AD + rTMS, and AD + Fer-1 groups (n = 6 per group). After 14 days of intervention, cognitive performance was assessed using behavioral tests. Whole-cell patch-clamp recordings were performed in hippocampal dentate gyrus granule neurons to evaluate neuronal excitability and voltage-gated sodium (Na⁺) and potassium (K⁺) channel properties. Biochemical assays and transmission electron microscopy were used to assess oxidative, iron-related, and mitochondrial changes, and mitochondrial ultrastructure was examined in an independent cohort (n = 3 per group) using transmission electron microscopy. Results: Compared with AD + Sham mice, high-frequency rTMS improved cognitive performance, increased evoked action potential firing, lowered the elevated action potential threshold, partially restored voltage-gated Na⁺ and K⁺ current amplitudes, and accelerated recovery of Na⁺ currents from inactivation. Fer-1 produced partially overlapping, but not identical, effects across behavioral, electrophysiological, biochemical, and ultrastructural outcomes. Both interventions increased hippocampal glutathione (GSH) levels, reduced malondialdehyde (MDA) and total iron levels, partially restored superoxide dismutase (SOD) activity, and improved mitochondrial ultrastructure and reduced the prevalence of mitochondrial profiles with small cross-sectional areas. Conclusions: High-frequency rTMS improved cognitive and hippocampal neuronal outcomes in female APP/PS1 mice. These improvements were accompanied by biochemical and mitochondrial changes compatible with attenuation of ferroptosis-related injury. However, the findings do not establish ferroptosis inhibition as either necessary or sufficient for the effects of rTMS. Full article

Traumatic brain injury (TBI) is a leading cause of long-term neurological disability worldwide and is frequently associated with persistent impairments in consciousness, cognition, mood, and functional independence. Despite advances in acute neurocritical care, effective therapies that enhance neurological recovery remain limited. Neuromodulation has emerged as a promising strategy to augment neuroplasticity and improve recovery through both pharmacologic and non-pharmacologic approaches. This narrative review summarizes current evidence supporting pharmacologic neuromodulatory therapies, including central nervous system stimulants (methylphenidate and modafinil), dopaminergic agents (amantadine and bromocriptine), acetylcholinesterase inhibitors (donepezil and rivastigmine), and selective serotonin reuptake inhibitors (sertraline and fluoxetine). Mechanisms of action, clinical efficacy, adverse effects, and practical considerations across the acute, subacute, and chronic phases of TBI recovery are discussed. Emerging non-pharmacologic neuromodulation techniques, including repetitive transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, vagus nerve stimulation, and deep brain stimulation, are also reviewed. Although amantadine remains the only neuromodulator supported by moderate-quality guideline recommendations for accelerating recovery in disorders of consciousness, accumulating evidence suggests that several additional pharmacologic and non-pharmacologic neuromodulation interventions may improve attention, executive function, fatigue, mood, and rehabilitation participation in carefully selected patients. However, current evidence is limited by heterogeneous study populations, small sample sizes, inconsistent outcome measures, and a paucity of long-term randomized controlled trials. Future research should prioritize adequately powered comparative studies, standardized outcome measures, biomarker-guided patient selection, and multimodal treatment strategies to optimize neurological recovery following TBI. Full article

Gamma-band oscillations centered around 40 Hz play an important role in cortical communication, and their disruption has been documented as a neurophysiological feature of several neurodegenerative and neuropsychiatric disorders. This narrative review synthesizes preclinical and early-phase clinical evidence for 40 Hz non-invasive brain stimulation across five delivery modalities: (1) auditory stimulation, which leverages the 40 Hz auditory steady-state response (ASSR) to probe parvalbumin-positive (PV⁺) interneuron circuits and serves as a validated neurophysiological biomarker in schizophrenia; (2) visual stimulation, using luminance or invisible spectral flicker to induce steady-state visually evoked potentials (SSVEPs) and, in animal models, to activate microglial phagocytosis; (3) transcranial alternating current stimulation (tACS), which delivers sinusoidal sub-threshold membrane polarization at gamma frequency, with preliminary case-series evidence suggesting tau burden reduction and EEG-based biomarker changes in Alzheimer’s disease; (4) repetitive transcranial magnetic stimulation (rTMS), offering focal cortical entrainment that, when combined with tACS in phase-synchronized protocols, produces sustained gamma enhancement in the dorsolateral prefrontal cortex; and (5) multisensory combined stimulation, which engages multiple convergent pathways and currently represents the approach with the most promising early translational signal, including cognitive stabilization and hippocampal volume preservation in small AD trials. While single-session entrainment does not reliably yield cognitive gains, multi-week applications have shown neurophysiological and preliminary biomarker-level changes in selected populations. It should be emphasized, however, that the human evidence base remains early-phase and largely derived from small, often uncontrolled studies; 40 Hz stimulation should accordingly be regarded as a biologically plausible and well-tolerated investigational approach rather than an established therapeutic intervention. Adequately powered, randomized, sham-controlled trials are required before clinical conclusions can be drawn. Full article

Magnetic stimulation modulates hippocampal synaptic plasticity in a parameter-dependent manner with effects shaped by stimulation frequency, intensity, waveform, and exposure conditions. Low-intensity magnetic fields generate induced electric fields that can influence neuronal membrane excitability and neural network activity. Hippocampal long-term potentiation (LTP) and long-term depression (LTD) are widely used as important readouts for evaluating the neurobiological effects of magnetic stimulation. Previous studies have shown that extremely low-frequency magnetic fields (ELF-MFs) may enhance, inhibit, or have no effect on LTP. These divergent effects appear to depend on stimulation conditions, developmental stage, and the baseline state of the neural network. High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) has been reported to promote the recovery of LTP-like plasticity, improve synaptic structure, and regulate the expression of neurotrophic factors in some aging or pathological models. However, its effects are still influenced by both stimulation parameters and biological states. The underlying mechanisms may involve multiple levels of regulation, including Ca²⁺ dynamics, neurotrophic signals, glutamate receptor dynamics, mitochondrial function, and network oscillations. However, these mechanisms have been inferred mainly from various experimental models, and their interactions, temporal sequence, and causal relationships still need further clarification. Micro-magnetic stimulation (μMS) offers a potential technical approach for improving the spatial selectivity of local regulation in the hippocampus. Arrayed and wireless μMS platforms have further expanded their potential applications. However, available evidence has been obtained primarily from in vitro experiments and animal models. This review summarizes the effects of magnetic stimulation with different parameter configurations on hippocampal synaptic plasticity, integrates the biological mechanisms underlying cross-frequency magnetic neuromodulation, and discusses current challenges in the field of magnetic neuromodulation and future directions toward translational development. Full article

Background/Objectives: Stroke-related aphasia significantly impairs communication and quality of life (QoL). Constraint-induced aphasia therapy (CIAT) and repetitive transcranial magnetic stimulation (rTMS) are evidence-based approaches targeting language recovery. No combined protocol exists for Greek, a morphologically complex language. The present study was designed as a feasibility pilot, with the primary objective of determining if a modified CIAT (mCIAT) protocol, with or without continuous theta burst stimulation (cTBS), could be delivered safely and acceptably in a Cypriot clinical context, while also reporting the first mCIAT protocol adapted for Greek. Methods: A single-subject experimental design (SSED) was employed. Two participants (PAs) with chronic anomic aphasia underwent a 10-day treatment protocol. PA1 received sham cTBS plus mCIAT-GR; PA2 received real cTBS (to the right inferior frontal gyrus) plus mCIAT. Multiple language, cognitive, and QoL measures were administered across three baselines and two follow-up time points. Results: Both PAs completed the full protocol with 100% session adherence and no adverse effects, establishing the feasibility of delivery. Neither participant showed improvements in standardized expressive language measures following mCIAT with or without cTBS; Standard Error of Measurement (SEM) analysis confirmed that observed score fluctuations on most measures fell within expected measurement noise. PA2 showed improvement in QoL (SAQOL-39g) domains at the two-year follow-up, though this finding requires cautious interpretation given the follow-up interval and regression-to-mean considerations. Conclusions: The Greek mCIAT protocol is feasible and safe to deliver in a Cypriot clinical setting. The absence of clear language improvements may reflect several factors, including ceiling effects, limited assessment sensitivity, insufficient treatment dosage, or limited intervention effects. These findings should be interpreted cautiously and require confirmation in larger, adequately powered studies. Full article

Introduction: Adult-onset Alexander disease (AOAD) is a rare astrocytopathy linked to the glial fibrillary acidic protein (GFAP) gene, which is known for its clinical heterogeneity and common misdiagnosis. In adults, it may present with bulbar dysfunction, pyramidal signs, ataxia, dysautonomia, cognitive decline, or parkinsonism, which often mimics atypical parkinsonian syndromes like multiple system atrophy (MSA). The purpose of this case series was to define practical clinical, radiological, and genetic cues for suspecting AOAD in adults with atypical parkinsonism, autonomic dysfunction, or paroxysmal focal symptoms, particularly when genetic findings are inconclusive. Case Presentation: Four patients, aged 40 to 59 years, had progressive and varied neurological symptoms, like gait disturbance, lower limb weakness, dysarthria, dysphagia, autonomic dysfunction, parkinsonism, cognitive decline, and paroxysmal focal deficits. Initial diagnoses were parkinsonian syndrome, stroke, transient ischemic attack (TIA), and MSA. Diagnostic Assessment and Intervention: Brain magnetic resonance imaging (MRI) in all patients showed characteristic lower brainstem abnormalities, particularly atrophy of the medulla oblongata and upper cervical spinal cord, consistent with the “tadpole sign.” GFAP sequencing identified one likely pathogenic variant (p.Arg70Trp) and three variants of uncertain significance: p.Glu122_Arg124del, p.Met415Ile, and p.Glu195Val. Management was mainly symptomatic; one patient showed significant motor improvement after repetitive transcranial magnetic stimulation (rTMS). Conclusions: AOAD should be considered in adults with parkinsonism-plus syndromes or unexplained combinations of bulbar symptoms, pyramidal signs, autonomic dysfunction, and cognitive decline. Recognizing the tadpole sign on MRI may improve diagnostic accuracy, particularly when genetic results are inconclusive. Full article

Background/Objectives: As cancer survival improves, rehabilitation has become an increasingly important component of comprehensive oncology care, addressing the growing burden of treatment-related impairments. Although electrotherapy modalities are widely used in Physical and Rehabilitation Medicine, their application in oncology remains controversial because of persistent concerns regarding safety and potential interactions with tumor biology. This narrative review critically evaluates the current evidence regarding the clinical applications, safety, contraindications, and therapeutic potential of electrotherapy modalities in oncology rehabilitation. Methods: A structured literature search was performed in PubMed, Scopus, and Web of Science for studies published between January 2000 and March 2026. Evidence from randomized controlled trials, observational studies, systematic reviews, meta-analyses, clinical practice guidelines, consensus statements, and narrative reviews was analyzed. Results: The strongest clinical evidence supports transcutaneous electrical nerve stimulation (TENS), photobiomodulation (PBM)/low-level laser therapy (LLLT), neuromuscular and functional electrical stimulation (NMES/FES), Deep Oscillation Therapy, and extracorporeal shock wave therapy (ESWT) for selected supportive indications in oncology rehabilitation. Therapeutic ultrasound, pulsed electromagnetic field therapy (PEMF), repetitive transcranial magnetic stimulation (rTMS), Multiwave Locked System (MLS) laser, and shortwave diathermy show promising but still limited clinical evidence, whereas oncology-specific evidence remains insufficient for interferential currents, diadynamic currents, high-intensity laser therapy (HILT), Super Inductive System (SIS), and transfer of capacitive and resistive energy (TECAR) therapy. Conclusions: Electrotherapy in oncology rehabilitation should be considered a prescription-based therapeutic intervention rather than a group of interchangeable physical modalities. As with pharmacological therapy, treatment efficacy and safety depend on selecting the appropriate modality, establishing the correct indication, and prescribing appropriate dosimetry and treatment parameters. Current evidence supports an individualized, evidence-informed approach that integrates the biological effects of each modality with the patient’s oncological status, rehabilitation goals, and overall clinical condition, with the ultimate aim of improving function, symptom control, and quality of life. Full article

Background/Objectives: Repetitive transcranial magnetic stimulation (rTMS) has been increasingly investigated as an adjunctive intervention in neurorehabilitation, particularly for motor recovery after stroke. However, conventional rTMS protocols remain limited by variability in target localization, inter-individual anatomical differences, lesion-related network reorganization, and limited reproducibility across treatment sessions. Neuronavigated repetitive transcranial magnetic stimulation (nrTMS) integrates structural neuroimaging with real-time coil tracking, enabling more precise and reproducible stimulation of patient-specific cortical targets. This approach may be especially relevant in patients with focal brain lesions, postoperative anatomical distortion, or functionally reorganized networks. Methods: This narrative review summarizes the biological rationale, current clinical evidence, practical workflow, and limitations of nrTMS in neurorehabilitation, with particular attention to the distinction between conventional rTMS and neuronavigated protocols. Results: The strongest evidence for rTMS-based rehabilitation remains in post-stroke motor recovery, although most studies have used non-navigated protocols. In contrast, postoperative neuro-oncological rehabilitation represents a clinically relevant but still investigational context for nrTMS, as preoperative functional mapping, postoperative deficits, and early rehabilitation can be integrated within a patient-specific therapeutic pathway. Early studies suggest feasibility when stimulation is combined with structured physiotherapy; however, the available evidence is based on small and heterogeneous cohorts, and clinically meaningful superiority over conventional rTMS or standard rehabilitation has not yet been established. Data in traumatic brain injury, multiple sclerosis, ataxias, and neurodegenerative disorders are still preliminary and heterogeneous. Conclusions: Neuronavigation should not be interpreted as an independent therapeutic breakthrough, but rather as a precision-enhancing component of rTMS-based rehabilitation. Its main potential value lies in improving targeting accuracy, session-to-session reproducibility, and integration with individualized neuroimaging and rehabilitation goals. Accordingly, nrTMS should currently be considered a precision-enhancing and hypothesis-generating framework rather than an established rehabilitation standard. Full article

Background: Major depressive disorder, particularly in its treatment-resistant form, remains a leading cause of global disability. When pharmacotherapy and psychotherapy fail, neuromodulation techniques such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) are increasingly utilized. However, variability in protocols and outcome reporting continues to generate uncertainty regarding their comparative benefits and safety profiles. Objective: To comprehensively map and synthesize the available evidence on the clinical benefits and adverse effects of ECT and rTMS in adults with major depressive disorder and treatment-resistant depression. Methods: A scoping review was conducted following PRISMA-Sc guidelines and registered in PROSPERO; PubMed–MEDLINE, Scopus, and the Virtual Health Library were searched from inception to October 2022. Observational and experimental studies evaluating ECT and or rTMS in adults with depressive disorders were included. Data were extracted on study design, population characteristics, stimulation parameters, clinical outcomes, and adverse effects. Methodological quality was assessed using National Heart, Lung, and Blood Institute tools. Results: A total of 165 studies comprising 10,701 participants were included. ECT and rTMS were consistently associated with clinically meaningful reductions in depressive symptom severity across heterogeneous protocols. ECT demonstrated the most robust response rates, particularly in treatment-resistant and severe depression, while rTMS showed substantial efficacy with a more favorable safety profile. Adverse effects were more frequent and severe with ECT, including transient cognitive disturbances and cardiovascular complications, whereas rTMS was predominantly associated with mild, self-limited side effects such as headache and scalp discomfort. Considerable heterogeneity in stimulation parameters and diagnostic subgroups was observed across studies. Conclusions: Both ECT and rTMS represent effective neuromodulation strategies for major depressive disorder and treatment-resistant depression. ECT remains the most potent intervention in highly refractory cases, whereas rTMS offers a less invasive alternative with strong tolerability. Standardization of stimulation protocols, biomarker-informed stratification, coadjuvancy analysis, and long-term controlled studies are necessary to refine clinical positioning and advance precision neuromodulation in depression care. Full article

Background/Objectives: Low-intensity repetitive transcranial magnetic stimulation (Li-rTMS) is an emerging non-invasive neuromodulation approach for fibromyalgia; however, large-scale data on safety and tolerability in routine clinical settings remain limited. This study aimed to evaluate the safety and tolerability of Li-rTMS in patients with fibromyalgia treated in outpatient practice. Methods: A retrospective multicentre observational cohort study was conducted using routinely collected clinical data from nine outpatient centres (November 2020–March 2026). Safety analyses included all patients initiating Li-rTMS treatment (intention-to-treat cohort, n = 1381). The protocol consisted of eight stimulation sessions delivered using a CE-certified medical device. Patient-reported tolerability and perceived symptom changes in three predefined domains (headache, generalized pain, and sleep) were assessed using a standardized 0–10 scale and analysed descriptively, with stratification by age group. Results: Li-rTMS was generally well tolerated across all age groups, including those >65 years. High-intensity symptom worsening was infrequent (headache 3.8%, generalized pain 6.1%, sleep disturbances 2.1%), predominantly mild and self-limited. No serious adverse events were spontaneously reported or clinically identified during routine clinical follow-up, within the limitations inherent to a real-world passive registry framework. Exploratory observations from patient-initiated recall sessions did not suggest an increased adverse symptom burden with repeated exposure. Conclusions: Li-rTMS demonstrated a favourable patient-reported tolerability profile among patients with available follow-up data, characterized by a low frequency of transient high-intensity symptom worsening and the absence of serious adverse events spontaneously reported or clinically identified during routine, non-systematic follow-up. These findings support the feasibility of repeated Li-rTMS administration in outpatient settings; however, due to the observational design and non-systematic follow-up, no conclusions regarding clinical efficacy can be drawn. Full article

Background/Objectives: Post-stroke dysphagia (PSD) is a common complication following cerebrovascular events, and many affected patients also present with pre-existing dementia or post-stroke cognitive impairment (PSCI). PSD primarily affects the oropharyngeal phase of swallowing, whereas cognitive impairment often compromises the oral phase. This overlap complicates diagnosis and highlights the importance of accurate assessment to guide appropriate treatment strategies. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising therapeutic intervention for both cognitive impairment and dysphagia. Methods: In this study, we report a case of a patient with pre-existing dementia who experienced an ischemic stroke, resulting in PSD and PSCI. Videofluoroscopic swallowing study (VFSS) revealed oral-phase-predominant dysphagia. rTMS targeting the dorsolateral prefrontal cortex (DLPFC) was administered with the aim of enhancing cognitive function. Results: Following two cycles of rTMS in combination with ongoing swallowing therapy, the patient demonstrated notable improvement in both cognitive and swallowing function. Conclusions: Although limited by a single-case design and the possibility of spontaneous recovery, this case demonstrates that rTMS targeting the DLPFC combined with swallowing therapy may be a potential intervention for managing concurrent post-stroke dysphagia and cognitive impairment. Full article