Transcranial Magnetic Stimulation for the Neurological Patient: Scientific Principles and Applications

Abstract

Non-invasive brain stimulation has been increasingly recognized for its potential as an investigational, diagnostic and therapeutic tool across the clinical neurosciences. Transcranial magnetic stimulation (TMS) is a non-invasive method of focal neuromodulation. Diagnostically, TMS can be used to probe cortical excitability and plasticity, as well as for functional mapping. Therapeutically, depending on the pattern employed, TMS can either facilitate or inhibit stimulated cortex potentially modulating maladaptive physiology through its effects on neuroplasticity. Despite this potential, applications of TMS in neurology have only been approved for diagnostic clinical neurophysiology, pre-surgical mapping of motor and language cortex, and the treatment of migraines. In this article, we discuss the principles of TMS and its clinical applications in neurology, including experimental applications in stroke rehabilitation, seizures, autism spectrum disorder, neurodegenerative disorders, movement disorders, tinnitus, chronic pain and functional neurological disorder. To promote increased cross-talk across neurology and psychiatry, we also succinctly review the TMS literature for the treatment of major depression and obsessive compulsive disorder. Overall, we argue that larger clinical trials that are better informed by circuit-level biomarkers and pathophysiological models will lead to an expansion of the application of TMS for patients cared for by neurologists.

Regulatory Clearance and Approval of Therapeutic Protocols of Transcranial Magnetic Stimulation for Psychiatric Disorders

“…Finally, TMS has also been studied to treat other not strictly psychiatric disorders, such as the cognitive symptoms of Alzheimer's disease and tinnitus, but are yet to be approved by regulatory authorities [40]. Further details on the use of TMS for these or other non-psychiatric indication are available in systematic reviews [82,83] and expert guidelines and recommendations [40], frequently used to decide on off-label use. A summary of recommendations based on the level of evidence of TMS for the treatment of psychiatric disorders, as presented in Lefaucheur et al, is presented in Table 2.…”

The Use of Transcranial Magnetic Stimulation in Attention Optimization Research: A Review from Basic Theory to Findings in Attention-Deficit/Hyperactivity Disorder and Depression

“…This network-level impact is crucial for understanding how TMS can modulate broader brain functions. In a clinical context, TMS is applied therapeutically, with repetitive sessions potentially leading to longer-lasting changes in neural activity [ 66 ]. In summary, TMS works by inducing electrical currents in the brain through a changing magnetic field, leading to neuronal activation or inhibition.…”

Toward a Unified Classification System for Brain–Mind Disorders: Putting Calls for Integrated Clinical Neuroscience Into Action

“…We call upon the American Neuropsychiatric Association, Society for Behavioral and Cognitive Neurology, Society for Biological Psychiatry, American Board of Psychiatry and Neurology, United Council of Neurologic Subspecialties, and professional groups of broader scope (ie, American Psychiatric Association, American Academy of Neurology, allied international organizations) to convene a multidisciplinary committee that is tasked to formulate a nosological framework for the full spectrum of brain–mind disorders. Such an approach would seek to address how cognitive–affective–sensorimotor–behavioral–perceptual symptoms arise; how partially overlapping conditions relate based on structural and functional neurocircuit alterations; and how treatment through psychotherapy, pharmacology, neurostimulation, and other rehabilitative techniques adaptively modifies brain networks (Eldaief et al, 2022).…”