Elsevier

The Lancet Neurology

Volume 2, Issue 3, March 2003, Pages 145-156
The Lancet Neurology

Review
Transcranial magnetic stimulation in neurology

https://doi.org/10.1016/S1474-4422(03)00321-1Get rights and content

Summary

Transcranial magnetic stimulation (TMS) is a non-invasive tool for the electrical stimulation of neural tissue, including cerebral cortex, spinal roots, and cranial and peripheral nerves. TMS can be applied as single pulses of stimulation, pairs of stimuli separated by variable intervals to the same or different brain areas, or as trains of repetitive stimuli at various frequencies. Single stimuli can depolarise neurons and evoke measurable effects. Trains of stimuli (repetitive TMS) can modify excitability of the cerebral cortex at the stimulated site and also at remote areas along functional anatomical connections. TMS might provide novel insights into the pathophysiology of the neural circuitry underlying neurological and psychiatric disorders, be developed into clinically useful diagnostic and prognostic tests, and have therapeutic uses in various diseases. This potential is supported by the available studies, but more work is needed to establish the role of TMS in clinical 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

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

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