Transcranial magnetic stimulation of the brain: What is stimulated? - A consensus and critical position paper
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Transcranial magnetic stimulation of the brain: What is stimulated? - A consensus and critical position paper. / Siebner, Hartwig Roman; Funke, Klaus; Aberra, Aman S; Antal, Andrea; Bestmann, Sven; Chen, Robert; Classen, Joseph; Davare, Marco; Di Lazzaro, Vincenzo; Fox, Peter T; Hallett, Mark; Karabanov, Anke Ninija; Kesselheim, Janine; Beck, Mikkel Malling; Koch, Giacomo; Liebetanz, David; Meunier, Sabine; Miniussi, Carlo; Paulus, Walter; Peterchev, Angel V; Popa, Traian; Ridding, Michael C; Thielscher, Axel; Ziemann, Ulf; Rothwell, John C; Ugawa, Yoshikazu.
In: Clinical Neurophysiology, Vol. 140, 2022, p. 59-97.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - Transcranial magnetic stimulation of the brain: What is stimulated? - A consensus and critical position paper
AU - Siebner, Hartwig Roman
AU - Funke, Klaus
AU - Aberra, Aman S
AU - Antal, Andrea
AU - Bestmann, Sven
AU - Chen, Robert
AU - Classen, Joseph
AU - Davare, Marco
AU - Di Lazzaro, Vincenzo
AU - Fox, Peter T
AU - Hallett, Mark
AU - Karabanov, Anke Ninija
AU - Kesselheim, Janine
AU - Beck, Mikkel Malling
AU - Koch, Giacomo
AU - Liebetanz, David
AU - Meunier, Sabine
AU - Miniussi, Carlo
AU - Paulus, Walter
AU - Peterchev, Angel V
AU - Popa, Traian
AU - Ridding, Michael C
AU - Thielscher, Axel
AU - Ziemann, Ulf
AU - Rothwell, John C
AU - Ugawa, Yoshikazu
N1 - Copyright © 2022 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.
PY - 2022
Y1 - 2022
N2 - Transcranial (electro)magnetic stimulation (TMS) is currently the method of choice to non-invasively induce neural activity in the human brain. A single transcranial stimulus induces a time-varying electric field in the brain that may evoke action potentials in cortical neurons. The spatial relationship between the locally induced electric field and the stimulated neurons determines axonal depolarization. The induced electric field is influenced by the conductive properties of the tissue compartments and is strongest in the superficial parts of the targeted cortical gyri and underlying white matter. TMS likely targets axons of both excitatory and inhibitory neurons. The propensity of individual axons to fire an action potential in response to TMS depends on their geometry, myelination and spatial relation to the imposed electric field and the physiological state of the neuron. The latter is determined by its transsynaptic dendritic and somatic inputs, intrinsic membrane potential and firing rate. Modeling work suggests that the primary target of TMS is axonal terminals in the crown top and lip regions of cortical gyri. The induced electric field may additionally excite bends of myelinated axons in the juxtacortical white matter below the gyral crown. Neuronal excitation spreads ortho- and antidromically along the stimulated axons and causes secondary excitation of connected neuronal populations within local intracortical microcircuits in the target area. Axonal and transsynaptic spread of excitation also occurs along cortico-cortical and cortico-subcortical connections, impacting on neuronal activity in the targeted network. Both local and remote neural excitation depend critically on the functional state of the stimulated target area and network. TMS also causes substantial direct co-stimulation of the peripheral nervous system. Peripheral co-excitation propagates centrally in auditory and somatosensory networks, but also produces brain responses in other networks subserving multisensory integration, orienting or arousal. The complexity of the response to TMS warrants cautious interpretation of its physiological and behavioural consequences, and a deeper understanding of the mechanistic underpinnings of TMS will be critical for advancing it as a scientific and therapeutic tool.
AB - Transcranial (electro)magnetic stimulation (TMS) is currently the method of choice to non-invasively induce neural activity in the human brain. A single transcranial stimulus induces a time-varying electric field in the brain that may evoke action potentials in cortical neurons. The spatial relationship between the locally induced electric field and the stimulated neurons determines axonal depolarization. The induced electric field is influenced by the conductive properties of the tissue compartments and is strongest in the superficial parts of the targeted cortical gyri and underlying white matter. TMS likely targets axons of both excitatory and inhibitory neurons. The propensity of individual axons to fire an action potential in response to TMS depends on their geometry, myelination and spatial relation to the imposed electric field and the physiological state of the neuron. The latter is determined by its transsynaptic dendritic and somatic inputs, intrinsic membrane potential and firing rate. Modeling work suggests that the primary target of TMS is axonal terminals in the crown top and lip regions of cortical gyri. The induced electric field may additionally excite bends of myelinated axons in the juxtacortical white matter below the gyral crown. Neuronal excitation spreads ortho- and antidromically along the stimulated axons and causes secondary excitation of connected neuronal populations within local intracortical microcircuits in the target area. Axonal and transsynaptic spread of excitation also occurs along cortico-cortical and cortico-subcortical connections, impacting on neuronal activity in the targeted network. Both local and remote neural excitation depend critically on the functional state of the stimulated target area and network. TMS also causes substantial direct co-stimulation of the peripheral nervous system. Peripheral co-excitation propagates centrally in auditory and somatosensory networks, but also produces brain responses in other networks subserving multisensory integration, orienting or arousal. The complexity of the response to TMS warrants cautious interpretation of its physiological and behavioural consequences, and a deeper understanding of the mechanistic underpinnings of TMS will be critical for advancing it as a scientific and therapeutic tool.
KW - Faculty of Science
KW - Transcranial magnetic stimulation
KW - Motor cortex
KW - Mechanism of action
KW - Physiology
U2 - 10.1016/j.clinph.2022.04.022
DO - 10.1016/j.clinph.2022.04.022
M3 - Review
C2 - 35738037
VL - 140
SP - 59
EP - 97
JO - Electroencephalography and Clinical Neurophysiology - Electromyography and Motor Control
JF - Electroencephalography and Clinical Neurophysiology - Electromyography and Motor Control
SN - 1388-2457
ER -
ID: 311601956