Transcranial magnetic stimulation in exploring neurophysiology of cortical circuits and potential clinical implications

Abstract

Transcranial magnetic stimulation (TMS) is a non-invasive, painless technique to stimulate the human brain. Although it has been used in clinical research both as an investigative tool and treatment modality for the past three decades, its use has been restricted to tertiary health centres or higher-end academic research institutions. The aim of this review is to popularise the concepts of this effective non-invasive brain stimulation technique, further facilitating its use both in research and clinical practice among clinical physiologists. In the first part of this article, a brief physiologic overview of TMS will be provided with basic as well as the basic technical details. This is followed by a discussion of TMS parameters that can be studied using single and paired pulses of TMS which could be used to investigate the altered excitability of cortical circuits. Finally, how rTMS and patterned TMS could be used to induce plasticity which, in turn, could be potentially used as therapeutic interventions in various neurological and psychiatric disorders will be illustrated. In each section of this article, diagnostic as well as therapeutic utilities of TMS in Neurology and Psychiatric disorders will be discussed. These discussions could not only facilitate the understanding of pathophysiology of mood and movement disorders but also to manage various neurological and psychiatric disorders with novel therapeutic options. In the end, few future directions, limitations of this technique and comparison with other techniques will be provided. I hopefully, this review would elicit some interest in physiologists to take up this exciting area of brain stimulation as a research subject and work further on understanding the functions of brain and use it effectively in the management of various brain-related disorders.