Semin Neurol 2022; 42(02): 149-157
DOI: 10.1055/s-0041-1742265
Review Article

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

Mark C. Eldaief
1   Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
2   Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
3   Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
4   Department of Psychology, Center for Brain Science, Neuroimaging Facility, Harvard University, Cambridge, Massachusetts
,
Bradford C. Dickerson
2   Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
3   Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
,
Joan A. Camprodon
1   Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
2   Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
3   Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
› Author Affiliations
Funding M.C.E. reports grants or contracts from the the National Institutes of Health (NIH). J.A.C. reports grants or contracts from NIH, Harvard Brain Initiative, AE foundation, Gerstner Foundation, and Solinsky Foundation; Royalties or licenses from Springer; Consulting fees from Neuronetics; Patents planned, issued or pending from system and method for simultaneous electric field simulation and neuronavigation for TMS; Participation on a Data Safety Monitoring Board or Scientific Advisory Board from Hyka Therapeutics (SAB) and Feelmore Labs (SAB); Leadership or fiduciary role in other board, society, committee, or advocacy group from Program Committee ACNP, SOBP, ANPA; and stock or stock options from Hyka Therapeutics and Feelmore Labs. Participation on a Data Safety Monitoring Board or Advisory Board for Merck, Lilly; and Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid for Alzheimer's Association (Association for Frontotemporal Degeneration).

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.



Publication History

Article published online:
25 February 2022

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