Application of rTMS to the Motor Cortex in a Patient with Startle Reaction: A Case Report

Startle reaction is a physiological muscle reaction that occurs to protect against an unexpected, sudden stimulus. In this case, we wanted to discuss the response after the rTMS protocol, which we applied to our patient who had startle reactions that severely impair functionality and who did not meet the post traumatic stress disorders (PTSD) criteria or have a major brain lesion after a traffic accident. A 30-year-old single female patient who works as a stewardess in an airline company with no known history of physical or psychological illness but lost consciousness for about three hours after an in-vehicle traffic accident a week ago was admitted to our clinic. The patient had a history of having difficulty in doing her daily work due to the splashing movements that started in her body. No major brain lesion was detected in imaging studies. She did not meet the criteria for PTSD and her EEG results were normal. Medication did not help with the symptoms, so, rTMS was planned. After 6 sessions of rTMS, her movements had stopped completely. Our patient, who did not fully meet the criteria for PTSD and whose imaging and EEG results did not reveal any pathological findings had developed severe onset startle reactions after an in-vehicle traffic accident, fully responded to rTMS treatment and improved her functionality quickly and effectively. Thus, we think that rTMS should be investigated as an effective treatment method in such patients.