Transcranial magnetic stimulation
Diagnostic, therapeutic, and research potential
Abstract
Transcranial magnetic stimulation (TMS) is a 20-year-old technique originally introduced to noninvasively investigate nervous propagation along the corticospinal tract, spinal roots, and peripheral nerves in humans. TMS is extensively used in clinical neurophysiology, including rehabilitation and intraoperative monitoring. Single-pulse TMS and other more recent versions (paired-pulse TMS, repetitive TMS, integration with structural and functional MRI, and neuronavigation) allow motor output to be mapped precisely to a given body district. Moreover, TMS can be used to evaluate excitatory/inhibitory intracortical circuits and to provide information on brain physiology and pathophysiology of various neuropsychiatric diseases as well as on the mechanisms of brain plasticity and of neuroactive drugs. TMS applied over nonmotor areas made it possible to extend research applications (often complementary with other functional neuroimaging techniques) in several fields of psychophysiology, causally testing brain–behavior relationships. Being able to induce relatively long-lasting excitability changes, repetitive TMS has made the treatment of neuropsychiatric diseases linked with brain excitability dysfunctions possible. These uses, however, warrant further large-scale studies. In emerging fields of research, TMS-EEG co-registration is considered a promising approach to evaluate corticocortical connectivity and brain reactivity with high temporal resolution. However, safety and ethical limitations of TMS technique need a high level of vigilance.
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References
1.
Hallett M. Transcranial magnetic stimulation and the human brain. Nature 2000;406:147–150.
2.
Barker AT, Jalinous R, Freeston IL. Non invasive magnetic stimulation of the human motor cortex. Lancet 1985;1:1106–1107.
3.
Barker AT, Jalinous R, Freeston IL, Jarrat JA. Clinical evaluation of conduction time measurements in central motor pathways using magnetic stimulation of human brain. Lancet 1986;1:1325–1236.
4.
Rossini PM, Rossi S. Clinical applications of motor evoked potentials. Electroencephalogr Clin Neurophysiol 1998;106:180–194.
5.
Kobayashi M, Pascual Leone A. Transcranial magnetic stimulation in neurology. Lancet Neurol 2003;2:145–156.
6.
Rossini PM, Barker AT, Berardelli A, et al. Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application. Report of an IFCN committee. Electroencephalogr Clin Neurophysiol 1994;91:79–92.
7.
Di Lazzaro V, Oliviero A, Profice P, et al. The diagnostic value of motor evoked potentials. Clin Neurophysiol 1999;110:1297–1307.
8.
Curra A, Modugno N, Inghilleri M, et al. Transcranial magnetic stimulation techniques in clinical investigation. Neurology 2002;59:1851–1859.
9.
Cantello R. Applications of transcranial magnetic stimulation in movement disorders. J Clin Neurophysiol 2002;19:272–293.
10.
Hargreaves SJ, Watt JW. Intravenous anaesthesia and repetitive transcranial magnetic stimulation monitoring in spinal column surgery. Br J Anaesth 2005;94:70–73.
11.
Lemon RN, Johansson RS, Westling G. Corticospinal control during reach, grasp, and precision lift in man. J Neurosci 1995;15:6145–6156.
12.
Fadiga L, Fogassi L, Pavesi G, Rizzolatti G. Motor facilitation during action observation: a magnetic stimulation study. J Neurophysiol 1995;73:2608–2611.
13.
Rossini PM, Rossi S, Pasqualetti P, Tecchio F. Corticospinal excitability modulation to hand muscles during movement imagery. Cereb Cortex 1999;9:161–167.
14.
Ziemann U. TMS and drugs. Clin Neurophysiol 2004;115:1717–1729.
15.
Mortifee P, Stewart H, Schulzer M, Eisen A. Reliability of transcranial magnetic stimulation for mapping the human motor cortex. Electroencephalogr Clin Neurophysiol 1994;93:131–137.
16.
Rossini PM, Calautti C, Pauri F, Baron JC. Post-stroke plastic reorganisation in the adult brain. Lancet Neurol 2003;2:493–502.
17.
Ferreri F, Pauri F, Pasqualetti P, et al. Motor cortex excitability in Alzheimer's disease: a transcranial magnetic stimulation study. Ann Neurol 2003;53:102–108.
18.
Chen R, Cohen LG, Hallett M. Nervous system reorganization following injury. Neuroscience 2002;111:761–773.
19.
Pascual-Leone A, Dang N, Cohen LG, et al. Modulation of muscle responses evoked by transcranial stimulation during the acquisition of new fine motor skills. J Neurophysiol 1995;74:1037–1045.
20.
Gerloff C, Bushara K, Sailer A, et al. Multimodal imaging of brain reorganization in motor areas of the contralesional hemisphere of well recovered patients after capsular stroke Brain 2006;129:791–808. Epub ahead of print in 2005.
21.
Walsh V, Cowey A. Transcranial magnetic stimulation and cognitive neuroscience. Nat Rev Neurosci 2000;1:73–79.
22.
Rossi S, Rossini PM. TMS in cognitive plasticity and the potential for rehabilitation. Trends Cogn Sci 2004;8:273–279.
23.
Pascual-Leone A, Walsh V, Rothwell J. Transcranial magnetic stimulation in cognitive neuroscience—virtual lesion, chronometry, and functional connectivity. Curr Opin Neurobiol 2000;10:232–237.
24.
Wassermann EM, Lisanby SH. Therapeutic application of repetitive transcranial magnetic stimulation: a review. Clin Neurophysiol 2001;112:1367–1377.
25.
Pascual-Leone A, Rubio B, Pallardo F, Catala MD. Rapid-rate transcranial magnetic stimulation of left dorsolateral prefrontal cortex in drug-resistant depression. Lancet 1996;348:233–237.
26.
Couturier JL. Efficacy of rapid-rate repetitive transcranial magnetic stimulation in the treatment of depression: a systematic review and meta-analysis. J Psychiatry Neurosci 2005;30:83–90.
27.
Miniussi C, Bonato C, Bignotti S, et al. Repetitive transcranial magnetic stimulation (rTMS) at high and low frequency: an efficacious therapy for major drug-resistant depression? Clin Neurophysiol 2005;116:1062–1071.
28.
Cohen H, Kaplan Z, Kotler M, et al. Repetitive transcranial magnetic stimulation of the right dorsolateral prefrontal cortex in posttraumatic stress disorder: a double-blind, placebo-controlled study. Am J Psychiatry 2004;161:515–524.
29.
Hoffman RE, Gueorguieva R, Hawkins KA, et al. Temporoparietal transcranial magnetic stimulation for auditory hallucinations: safety, efficacy and moderators in a fifty patient sample. Biol Psychiatry 2005;58:97–104.
30.
Kleinjung T, Eichhammer P, Langguth B, et al. Long-term effects of repetitive transcranial magnetic stimulation (rTMS) in patients with chronic tinnitus. Otolaryngol Head Neck Surg 2005;132:566–569.
31.
Lefaucheur JP. Transcranial magnetic stimulation in the management of pain. Clin Neurophysiol (Suppl) 2004;57:737–748.
32.
Theodore WH. Transcranial magnetic stimulation in epilepsy. Epilepsy Curr 2003;3:191–197.
33.
Martin PI, Naeser MA, Theoret H, et al. Transcranial magnetic stimulation as a complementary treatment for aphasia. Semin Speech Lang 2004;25:181–191.
34.
Fregni F, Simon DK, Wu A, Pascual-Leone A. Non-invasive brain stimulation for Parkinson's disease: a systematic review and meta-analysis of the literature. J Neurol Neurosurg Psychiatry 2005;76:1614–1623.
35.
Mantovani A, Lisanby SH, Pieraccini F, et al. Repetitive transcranial magnetic stimulation (rTMS) in the treatment of obsessive-compulsive disorder (OCD) and Tourette's syndrome (TS). Int J Neuropsychopharmacol 2006;9:95–100.
36.
Koch G, Brusa L, Caltagirone C, et al. rTMS of supplementary motor area modulates therapy-induced dyskinesias in Parkinson disease. Neurology 2005;65:623–625.
37.
Khedr EM, Ahmed MA, Fathy N, Rothwell JC. Therapeutic trial of repetitive transcranial magnetic stimulation after acute ischemic stroke. Neurology 2005;65:466–468.
38.
Mansur CG, Fregni F, Boggio PS, et al. A sham stimulation-controlled trial of rTMS of the unaffected hemisphere in stroke patients. Neurology 2005;64:1802–1804.
39.
Rossini PM, Johnston CS. Facilitating acute stroke recovery with magnetic fields? Neurology 2005;65:353–354.
40.
Ziemann U. Improving disability in stroke with RTMS. Lancet Neurol 2005;4:454–455.
41.
De Ridder D, Verstraeten E, Van der Kelen K, et al. Transcranial magnetic stimulation for tinnitus: influence of tinnitus duration on stimulation parameter choice and maximal tinnitus suppression. Otol Neuro-otol 2005;26:616–619.
42.
Lefaucheur JP. Motor cortex dysfunction revealed by cortical excitability studies in Parkinson's disease: influence of antiparkinsonian treatment and cortical stimulation. Clin Neurophysiol 2005;116:244–253.
43.
Tassinari CA, Cincotta M, Zaccara G, Michelucci R. Transcranial magnetic stimulation and epilepsy. Clin Neurophysiol 2003;114:777–798.
44.
Belmaker B, Fitzgerald P, George MS, et al. Managing the risks of repetitive transcranial stimulation. CNS Spectr 2003;8:489.
45.
Wassermann EM. Report on risk and safety of repetitive transcranial magnetic stimulation (rTMS): suggested guidelines from the International Workshop on Risk and Safety of rTMS, June 5–7 1996. Electroencephalogr Clin Neurophysiol 1998;108:1–16.
46.
Huang YZ, Edwards MJ, Rounis E, Bhatia KP, Rothwell JC. Theta burst stimulation of the human motor cortex. Neuron 2005;45:201–206.
47.
Iyer MB, Schleper N, Wassermann EM. Priming stimulation enhances the depressant effect of low-frequency repetitive transcranial magnetic stimulation. J Neurosci 2003;23:10867–10872.
48.
Siebner HR, Lang N, Rizzo V, et al. Preconditioning of low-frequency repetitive transcranial magnetic stimulation with transcranial direct current stimulation: evidence for homeostatic plasticity in the human motor cortex. J Neurosci 2004;24:3379–3385.
49.
Boroojerdi B, Foltys H, Krings T, et al. Localization of the motor hand area using transcranial magnetic stimulation and functional magnetic resonance imaging. Clin Neurophysiol 1999;110:699–704.
50.
Herwig U, Schonfeldt-Lecuona C, Wunderlich AP, et al. The navigation of transcranial magnetic stimulation. Psychiatry Res 2001;108:123–131.
51.
Rounis E, Lee L, Siebner HR, et al. Frequency specific changes in regional cerebral blood flow and motor system connectivity following rTMS to the primary motor cortex. Neuroimage 2005;26:164–176.
52.
Bestmann S, Baudewig J, Siebner HR, Rothwell JC, Frahm J. Functional MRI of the immediate impact of transcranial magnetic stimulation on cortical and subcortical motor circuits. Eur J Neurosci 2004;19:1950–1962.
53.
Ilmoniemi RJ, Virtanen J, Ruohonen J, et al. Neuronal responses to magnetic stimulation reveal cortical reactivity and connectivity. Neuroreport 1997;8:3537–3540.
54.
Komssi S, Kahkonen S, Ilmoniemi RJ. The effect of stimulus intensity on brain responses evoked by transcranial magnetic stimulation. Hum Brain Mapp 2004;21:154–164.
55.
Esser SK, Huber R, Massimini M, Peterson MJ, Ferrarelli F, Tononi G. A direct demonstration of cortical LTP in humans: a combined TMS/EEG study. Brain Res Bull 2006;69:86–94.
56.
Concor D. Happiness is a magnet. New Scientist August 5, 1995.
57.
Osborne L. Savant for a day. New York Times June 22, 2003.
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Published online: February 12, 2007
Published in issue: February 13, 2007
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