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

Steve Vucic; Kai-Hsiang Stanley Chen; Matthew C Kiernan; Mark Hallett; David H Benninger; Vincenzo Di Lazzaro; Paolo M Rossini; Alberto Benussi; Alfredo Berardelli; Antonio Currà; Sandro M Krieg; Jean-Pascal Lefaucheur; Yew Long Lo; Richard A Macdonell; Marcello Massimini; Mario Rosanova; Thomas Picht; Cathy M Stinear; Walter Paulus; Yoshikazu Ugawa; Ulf Ziemann; Robert Chen

doi:10.1016/j.clinph.2023.03.010

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

Clin Neurophysiol. 2023 Jun:150:131-175. doi: 10.1016/j.clinph.2023.03.010. Epub 2023 Mar 29.

Authors

Steve Vucic¹, Kai-Hsiang Stanley Chen², Matthew C Kiernan³, Mark Hallett⁴, David H Benninger⁵, Vincenzo Di Lazzaro⁶, Paolo M Rossini⁷, Alberto Benussi⁸, Alfredo Berardelli⁹, Antonio Currà¹⁰, Sandro M Krieg¹¹, Jean-Pascal Lefaucheur¹², Yew Long Lo¹³, Richard A Macdonell¹⁴, Marcello Massimini¹⁵, Mario Rosanova¹⁶, Thomas Picht¹⁷, Cathy M Stinear¹⁸, Walter Paulus¹⁹, Yoshikazu Ugawa²⁰, Ulf Ziemann²¹, Robert Chen²²

Affiliations

¹ Brain, Nerve Research Center, The University of Sydney, Sydney, Australia. Electronic address: steve.vucic@sydney.edu.au.
² Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
³ Brain and Mind Centre, The University of Sydney; and Department of Neurology, Royal Prince Alfred Hospital, Australia.
⁴ Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, Maryland, United States.
⁵ Department of Neurology, University Hospital of Lausanne (CHUV), Switzerland.
⁶ Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy.
⁷ Department of Neurosci & Neurorehab IRCCS San Raffaele-Rome, Italy.
⁸ Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
⁹ IRCCS Neuromed, Pozzilli; Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
¹⁰ Department of Medico-Surgical Sciences and Biotechnologies, Alfredo Fiorini Hospital, Sapienza University of Rome, Terracina, LT, Italy.
¹¹ Department of Neurosurgery, Technical University Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany.
¹² Univ Paris Est Creteil, EA4391, ENT, Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, AP-HP, Créteil, France.
¹³ Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, and Duke-NUS Medical School, Singapore.
¹⁴ Department of Neurology, Austin Health, Heidelberg VIC, Australia.
¹⁵ Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi di Milano, Milan, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy.
¹⁶ Department of Biomedical and Clinical Sciences University of Milan, Milan, Italy.
¹⁷ Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Cluster of Excellence: "Matters of Activity. Image Space Material," Humboldt University, Berlin Simulation and Training Center (BeST), Charité-Universitätsmedizin Berlin, Germany.
¹⁸ Department of Medicine Waipapa Taumata Rau, University of Auckland, Auckland, Aotearoa, New Zealand.
¹⁹ Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany.
²⁰ Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Japan.
²¹ Department of Neurology and Stroke, Eberhard Karls University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany; Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Otfried-Müller-Straße 27, 72076 Tübingen, Germany.
²² Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-UHN, Division of Neurology-University of Toronto, Toronto Canada.

Abstract

The review provides a comprehensive update (previous report: Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008;119(3):504-32) on clinical diagnostic utility of transcranial magnetic stimulation (TMS) in neurological diseases. Most TMS measures rely on stimulation of motor cortex and recording of motor evoked potentials. Paired-pulse TMS techniques, incorporating conventional amplitude-based and threshold tracking, have established clinical utility in neurodegenerative, movement, episodic (epilepsy, migraines), chronic pain and functional diseases. Cortical hyperexcitability has emerged as a diagnostic aid in amyotrophic lateral sclerosis. Single-pulse TMS measures are of utility in stroke, and myelopathy even in the absence of radiological changes. Short-latency afferent inhibition, related to central cholinergic transmission, is reduced in Alzheimer's disease. The triple stimulation technique (TST) may enhance diagnostic utility of conventional TMS measures to detect upper motor neuron involvement. The recording of motor evoked potentials can be used to perform functional mapping of the motor cortex or in preoperative assessment of eloquent brain regions before surgical resection of brain tumors. TMS exhibits utility in assessing lumbosacral/cervical nerve root function, especially in demyelinating neuropathies, and may be of utility in localizing the site of facial nerve palsies. TMS measures also have high sensitivity in detecting subclinical corticospinal lesions in multiple sclerosis. Abnormalities in central motor conduction time or TST correlate with motor impairment and disability in MS. Cerebellar stimulation may detect lesions in the cerebellum or cerebello-dentato-thalamo-motor cortical pathways. Combining TMS with electroencephalography, provides a novel method to measure parameters altered in neurological disorders, including cortical excitability, effective connectivity, and response complexity.

Keywords: Motor evoked potential; Neurological disorders; Short interval intracortical inhibition; Transcranial magnetic stimulation.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Alzheimer Disease*
Amyotrophic Lateral Sclerosis*
Evoked Potentials, Motor / physiology
Humans
Nervous System Diseases*
Transcranial Magnetic Stimulation / methods

Grants and funding

Z99 NS999999/ImNIH/Intramural NIH HHS/United States