Data for this review were identified by searches of Medline and the references from relevant articles; numerous articles were also identified through searches of our files. The search terms “transcranial magnetic stimulation” and “magnetic stimulation” were used in addition to several neurological diseases and those of internationally renowned experts in the use of TMS. Abstracts and reports from meetings were included only when no full paper has been published on the topic and the
ReviewTranscranial magnetic stimulation in neurology
Section snippets
Basic principles of magnetic stimulation
TMS, as currently used, was introduced by Anthony Barker (University of Sheffield, UK) in 1985.1 TMS provided, for the first time, a non-invasive, safe, and—unlike transcranial electrical stimulation (TES)—painless2 method of activating the human motor cortex and assessing the integrity of the central motor pathways. Since its introduction, the use of TMS in clinical neurophysiology, neurology, neuroscience, and psychiatry has spread widely, mostly in research applications, but increasingly
Diagnostic and prognostic applications of TMS
TMS delivered to different levels of the motor system (neuraxis) can provide information about the excitability of the motor cortex, the functional integrity of intracortical neuronal structures, the conduction along corticospinal, corticonuclear, and callosal fibres, as well as the function of nerve roots and peripheral motor pathway to the muscles. The patterns of findings in these studies can help to localise the level of a lesion within the nervous system, distinguish between a
The technique
A train of TMS pulses of the same intensity applied to a single brain area at a given frequency that can range from one stimulus per second to 20 or more is known as rTMS. The higher the stimulation frequency and intensity, the greater is the disruption of cortical function during the train of stimulation. However, after such immediate effects during the TMS train itself, a train of repetitive stimulation can also induce a modulation of cortical excitability. This effect may range from
Conclusion
TMS was introduced nearly 20 years ago and has developed as a sophisticated tool for neuroscience research. TMS is a non-invasive and effective methodology with potential diagnostic and therapeutic uses. Studies to date have not provided enough data to establish the clinical indication for a systematic application of TMS as a diagnostic or therapeutic tool in any neurological or psychiatric disease. Nevertheless, the ability of TMS to measure and modify cortical activity offers exciting
Search strategy and selection criteria
References (150)
- et al.
Non-invasive magnetic stimulation of human motor cortex
Lancet
(1985) - et al.
Clinical applications of motor evoked potentials
Electroencephalogr Clin Neurophysiol
(1998) - et al.
Transcranial magnetic stimulation coregistered with MRI: a comparison of a guided versus blind stimulation technique and its effect on evoked compound muscle action potentials
Clin Neurophysiol
(2001) - et al.
Motor cortex disinhibition in acute stroke
Clin Neurophysiol
(2000) - et al.
Proximal motor conduction evaluated by transcranial magnetic stimulation in acquired inflammatory demyelinating neuropathies
Clin Neurophysiol
(2001) - et al.
Transcranial magnetic stimulation: its current role in epilepsy research
Epilepsy Res
(1998) - et al.
Loss of the muscle silent period evoked by transcranial magnetic stimulation of the motor cortex in patients with cervical cord lesions
Neurosci Lett
(2000) - et al.
Interhemispheric inhibition in patients with multiple sclerosis
Electroencephalogr Clin Neurophysiol
(1998) - et al.
Low-frequency repetitive transcranial magnetic stimulation improves intractable epilepsy
Lancet
(1999) - et al.
Double magnetic stimulation of the motor cortex in amyotrophic lateral sclerosis
Electroencephalogr Clin Neurophysiol
(1998)