| Clinical neurophysiology  

Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee.

Transcranial magnetic stimulation (TMS) is a non-invasive technique for stimulating the human brain, currently used in the diagnosis and monitoring of several neurological diseases. A recent comprehensive update on clinical diagnostic utility of TMS in neurological disorders by a IFCN committee,1 provides new recommendations with respect to a previous document from 2008.

The paper describes in detail how to perform all main TMS techniques and the corresponding outcome measures. The summarized table on clinical diagnostic utility of TMS in neurological diseases provides an accurate guide for clinicians to interpret characteristic TMS findings in daily clinical practice and also in the research field.

Single-pulse TMS has established clinical utility in stroke, myelopathy, corticospinal lesions in multiple sclerosis correlating with motor impairment and disability, cervical/lumbosacral nerve-root function, especially in demyelinating neuropathies, and in localizing the site of facial nerve palsies. TMS can be used to perform functional mapping of eloquent brain regions in preoperative assessment before surgical resection of brain tumors. Cerebellar stimulation may also provide functional information on the cerebello-dentato-thalamo-motor cortical pathways. Paired-pulse TMS provides information on intra-cortical excitability in movement disorders, episodic (epilepsy, migraines), chronic pain, neurodegenerative and functional diseases. The authors finally point to combined TMS-EEG as a novel method to evaluate cortical excitability, effective connectivity and response complexity in several neurological disorders.

Key points:

  • Clinical diagnostic utility of TMS has been established in neurological disorders.
  • Paired-pulse TMS and TMS-EEG are proposed as additional tool for the assessment of, respectively,  cortical excitability and connectivity.

References:

  1. Vucic S, Stanley Chen KH, Kiernan MC, Hallett M, Benninger DH, Di Lazzaro V, Rossini PM, Benussi A, Berardelli A, Currà A, Krieg SM, Lefaucheur JP, Long Lo Y, Macdonell RA, Massimini M, Rosanova M, Picht T, Stinear CM, Paulus W, Ugawa Y, Ziemann U, Chen R. Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee. Clin Neurophysiol. 2023 Mar 29;150:131-175. doi: 10.1016/j.clinph.2023.03.010.
  2. Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, Mills K, Rösler KM, Triggs WJ, Ugawa Y, Ziemann U. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN ommittee. Clin Neurophysiol. 2008 Mar;119(3):504-532. doi: 10.1016/j.clinph.2007.10.014.

Publish on behalf of the Scientific Panel on Clinical neurophysiology

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