Transcranial Magnetic Stimulation

  • Masahito Kobayashi
  • Alvaro Pascual-Leone


During the past two decades, transcranial magnetic stimulation (TMS) has emerged as an important modality for the exploration of cerebral function and assessing the integrity of human motor pathways. In TMS, a strong magnetic pulse activates neural elements oriented predominantly horizontally to the brain surface, and a motor evoked potential can be recorded in the activated muscles. In single-pulse TMS, stimulation can be applied to different levels of the nervous system, including the spinal cord, to assist in localizing a lesion to a specific level and helping to characterize it as demyelinating or axonal in nature. A central motor conduction time can also be calculated; this is defined as the latency difference between the motor evoked potentials induced by stimulation of the motor cortex and those evoked by spinal (motor root) stimulation. A variety of additional testing paradigms have been created over the years, including the use of paired-pulse techniques and repetitive stimulation, the latter potentially assisting in treating a variety of disorders, including depression and Parkinson disease.

Key Words

Central conduction time excitability motor evoked potential repetitive stimulation silent period transcranial magnetic stimulation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Suggested Reading

  1. Berardelli A. Transcranial magnetic stimulation in movement disorders. Electroencephalogr Clin Neurophysiol 1999;51(Suppl): 276–280.Google Scholar
  2. Chen R, Gerloff C, Classen J, et al. Safety of different inter-train intervals for repetitive transcranial magnetic stimulation and recommendations for safe ranges of stimulation parameters. Electroencephalogr Clin Neurophys 1997;105: 415–421.CrossRefGoogle Scholar
  3. Ferbert A, Priori A, Rothwell JC, J, et al. Interhemispheric inhibition of the human motor cortex J Physiol 1992;453: 525–546PubMedGoogle Scholar
  4. Fitzgerald PB, Brown TL, Daskalakis ZJ. The application of transcranial magnetic stimulation in psychiatry and neurosciences research. Acta Psychiatr Scand 2002;105: 324–340.PubMedCrossRefGoogle Scholar
  5. Gugino LD, Romero JR, Aglio L, et al. Transcranial magnetic stimulation coregistered with MRI: a comparison of a guided versus blind stimulation technique and its effect on evoked compound muscle action potentials. Clin Neurophysiol 2001;112: 1781–1792.PubMedCrossRefGoogle Scholar
  6. Kobayashi M, Pascual-Leone. Transcranial magnetic stimulation in neurology. Lancet Neurology 2003;3: 145–156.CrossRefGoogle Scholar
  7. Kujirai T, Caramia MD, Rothwell JC, et al. Corticocortical inhibition in human motor cortex. J Physiol 1993;471: 501–519.PubMedGoogle Scholar
  8. Magistris MR, Rosier KM, Truffert A, et al. A clinical study of motor evoked potentials using a triple stimulation technique. Brain 1999; 122: 265–279.PubMedCrossRefGoogle Scholar
  9. Mills KR. Magnetic Stimulation of the Human Nervous System. Oxford University Press, Oxford, England, 1999.Google Scholar
  10. Pascual-Leone A, Davey N, Wassermann EM, Rothwell J, Puri BK, eds. Handbook of Transcranial Magnetic Stimulation. Arnold, London, UK, 2001.Google Scholar
  11. Pascual-Leone A, Valls-Sole J, Wassermann EM, Hallett M. Responses to rapid-rate transcranial magnetic stimulation of the human motor cortex. Brain 1994;117: 847–858.PubMedCrossRefGoogle Scholar
  12. Rossini PM. Is transcranial magnetic stimulation of the motor cortex a prognostic tool for motor recovery after stroke? Stroke 2000;31: 1463–1464.PubMedGoogle Scholar
  13. 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.PubMedCrossRefGoogle Scholar
  14. Rossini PM, Rossi S. Clinical applications of motor evoked potentials. Electroencephalogr Clin Neurophysiol 1998;106: 180–194.PubMedCrossRefGoogle Scholar
  15. Sparing R, Mottaghy FM, Ganis G, et al. Visual cortex excitability increases during visual mental imagery: a TMS study in healthy human subjects. Brain Res 2002;938: 92–97.PubMedCrossRefGoogle Scholar
  16. Ugawa Y, Hanajima R, Kanazawa I. Interhemispheric facilitation of the hand area of the human motor cortex. Neurosci Lett 1993;160: 153–155PubMedCrossRefGoogle Scholar
  17. Walsh V, Pascual-Leone A. Neurochronometrics of Mind: TMS in Cognitive Science. MIT Press, Cambridge, MA, 2003.Google Scholar
  18. Wassermann EM, Lisanby SH. Therapeutic application of repetitive transcranial magnetic stimulation: a review. Clin Neurophysiol 2001;112: 1367–1377.PubMedCrossRefGoogle Scholar
  19. Weber M, Eisen AA. Magnetic stimulation of the central and peripheral nervous systems. Muscle Nerve 2002;25: 160–175.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc. 2007

Authors and Affiliations

  • Masahito Kobayashi
    • 1
  • Alvaro Pascual-Leone
    • 2
  1. 1.Department of NeurosurgeryKeio University School of MedicineTokyoJapan
  2. 2.Department of Neurology, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBoston

Personalised recommendations