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

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

doi:10.1016/j.clinph.2023.03.010

Cited by 44 publications

(4 citation statements)

References 869 publications

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“…While targeting M1 CL with 1 Hz rTMS may be indicated in some individuals with specific lesion profiles, 28 group-level data in patients with stroke often fails to demonstrate evidence of hyperexcitability in M1 CL . 29 Targeting M1 of the affected corticospinal tract using excitatory rTMS may be more appropriate in patients with sufficient residual corticospinal tract integrity. Our sample population of participants with mixed lesion location and extent included ≈30% with lesions of the brainstem.…”

Section: Considerations For Future Studiesmentioning

confidence: 99%

Electric Field Navigated 1-Hz rTMS for Poststroke Motor Recovery: The E-FIT Randomized Controlled Trial

Edwards

Liu

Dunning

et al. 2023

Stroke

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BACKGROUND: To determine if low-frequency repetitive transcranial magnetic stimulation targeting the primary motor cortex contralateral (M1 CL ) to the affected corticospinal tract in patients with hemiparetic stroke augments intensive training–related clinical improvement; an extension of the NICHE trial (Navigated Inhibitory rTMS to Contralesional Hemisphere Trial) using an alternative sham coil. METHODS: The present E-FIT trial (Electric Field Navigated 1Hz rTMS for Post-stroke Motor Recovery Trial) included 5 of 12 NICHE trial outpatient US rehabilitation centers. The stimulation protocol remained identical (1 Hz repetitive transcranial magnetic stimulation, M1 CL , preceding 60-minute therapy, 18 sessions/6 wks; parallel arm randomized clinical trial). The sham coil appearance mimicked the active coil but without the weak electric field in the NICHE trial sham coil. Outcomes measured 1 week, and 1, 3, and 6 months after the end of treatment included the following: upper extremity Fugl-Meyer (primary, 6 months after end of treatment), Action Research Arm Test, National Institutes of Health Stroke Scale, quality of life (EQ-5D), and safety. RESULTS: Of 60 participants randomized, 58 completed treatment and were included for analysis. Bayesian analysis of combined data from the E-FIT and the NICHE trials indicated that active treatment was not superior to sham at the primary end point (posterior mean odds ratio of 1.94 [96% credible interval of 0.61–4.80]). For the E-FIT intent-to-treat population, upper extremity Fugl-Meyer improvement ≥5 pts occurred in 60% (18/30) active group and 50% (14/28) sham group. Participants enrolled 3 to 6 months following stroke had a 67% (31%–91% CI) response rate in the active group at the 6-month end point versus 50% in the sham group (21.5%–78.5% CI). There were significant improvements from baseline to 6 months for both active and sham groups in upper extremity Fugl-Meyer, Action Research Arm Test, and EQ-5D ( P <0.05). Improvement in National Institutes of Health Stroke Scale was observed only in the active group ( P =0.004). Ten serious unrelated adverse events occurred (4 active group, 6 sham group, P =0.72). CONCLUSIONS: Intensive motor rehabilitation 3 to 12 months after stroke improved clinical impairment, function, and quality of life; however, 1 Hz-repetitive transcranial magnetic stimulation was not an effective treatment adjuvant in the present sample population with mixed lesion location and extent. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03010462.

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Section: Considerations For Future Studiesmentioning

confidence: 99%

Electric Field Navigated 1-Hz rTMS for Poststroke Motor Recovery: The E-FIT Randomized Controlled Trial

Edwards

Liu

Dunning

et al. 2023

Stroke

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“…Given that ALS is a neurodegenerative disorder of upper and lower motor neurons, neurophysiological measures have emerged as important diagnostic and prognostic biomarkers. Specifically, the presence of cortical hyperexcitability reliably differentiates ALS from neuromuscular mimicking disorders and is an adverse prognostic biomarker 11 . At a lower motor neuron level, reduction of split hand and neurophysiological index appear to be useful diagnostic and prognostic biomarkers in ALS 12–14 .…”

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confidence: 99%

“…At a pathophysiological level, cortical hyperexcitability has been consistently identified as an important pathogenic biomarker of ALS, 11 correlating with lower motor neuron dysfunction and degeneration as reflected by conventional CMAP amplitudes 22,23 Cortical hyperexcitability has also been associated with disease progression and an adverse prognosis in ALS 24–26 . Given the pathogenic importance of cortical hyperexcitability in ALS, correlating FFP‐CMAP amplitudes with neurophysiological measures of cortical hyperexcitability, such as short interval intracortical inhibition (a biomarker of cortical inhibitory circuits), could provide novel insights into ALS pathogenesis.…”

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confidence: 99%

Clinical utility of far field motor potentials in amyotrophic lateral sclerosis

Vucic

2023

Muscle and Nerve

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“…The lack of correlation may relate to lower sensitivity of conventional nerve conduction studies in detecting specific sites of peripheral nerve dysfunction. Tibial nerve somatosensory evoked potentials38 and conus stimulation utilizing a large 20-cm-diameter Magnetic Augmented Translumbosacral Stimulation (MATS) coil39 may help clarify the role of proximal peripheral nerve segment dysfunction in CIDP related lower limb tremor.…”

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confidence: 99%

Imbalance and lower limb tremor in chronic inflammatory demyelinating polyradiculoneuropathy

Silsby

Yiannikas

Fois

et al. 2023

J Peripheral Nervous Sys

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Background and AimsImbalance is a prominent symptom of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Although upper limb tremor in CIDP is described, lower limb tremor has not been assessed. The aim of this study was to determine whether lower limb tremor was present in CIDP and assess potential relationships with imbalance.MethodsThis was a cross‐sectional observational study of prospectively recruited consecutive patients with typical CIDP (N = 25). Clinical phenotyping, lower limb nerve conduction and tremor studies, and posturography analyses were performed. The Berg Balance Scale (BBS) divided CIDP patients into those with “good” and “poor” balance.ResultsLower limb tremor was evident in 32% of CIDP patients and associated with poor balance (BBSTremor 35 [23–46], BBSNo Tremor 52 [44–55], p = .035). Tremor frequency was 10.2–12.5 Hz with legs outstretched and on standing, apart from four patients with a lower frequency tremor (3.8–4.6 Hz) while standing. Posturography analysis revealed a high‐frequency spectral peak in the vertical axis in 44% of CIDP patients (16.0 ± 0.4 Hz). This was more likely in those with “good” balance (40% vs. 4%, p = .013).InterpretationLower limb tremor is present in one third of CIDP patients and is associated with poor balance. A high‐frequency peak on posturography is associated with better balance in CIDP. Lower limb tremor and posturography assessments could serve as important biomarkers of balance in a clinical setting.

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

Cited by 44 publications

References 869 publications

Electric Field Navigated 1-Hz rTMS for Poststroke Motor Recovery: The E-FIT Randomized Controlled Trial

Electric Field Navigated 1-Hz rTMS for Poststroke Motor Recovery: The E-FIT Randomized Controlled Trial

Clinical utility of far field motor potentials in amyotrophic lateral sclerosis

Imbalance and lower limb tremor in chronic inflammatory demyelinating polyradiculoneuropathy

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