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      Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee

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          These guidelines provide an up-date of previous IFCN report on “Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application” ( Rossini et al., 1994). A new Committee, composed of international experts, some of whom were in the panel of the 1994 “Report”, was selected to produce a current state-of-the-art review of non-invasive stimulation both for clinical application and research in neuroscience.

          Since 1994, the international scientific community has seen a rapid increase in non-invasive brain stimulation in studying cognition, brain–behavior relationship and pathophysiology of various neurologic and psychiatric disorders. New paradigms of stimulation and new techniques have been developed. Furthermore, a large number of studies and clinical trials have demonstrated potential therapeutic applications of non-invasive brain stimulation, especially for TMS. Recent guidelines can be found in the literature covering specific aspects of non-invasive brain stimulation, such as safety ( Rossi et al., 2009), methodology ( Groppa et al., 2012) and therapeutic applications ( Lefaucheur et al., 2014).

          This up-dated review covers theoretical, physiological and practical aspects of non-invasive stimulation of brain, spinal cord, nerve roots and peripheral nerves in the light of more updated knowledge, and include some recent extensions and developments.

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          Event-related EEG/MEG synchronization and desynchronization: basic principles.

          An internally or externally paced event results not only in the generation of an event-related potential (ERP) but also in a change in the ongoing EEG/MEG in form of an event-related desynchronization (ERD) or event-related synchronization (ERS). The ERP on the one side and the ERD/ERS on the other side are different responses of neuronal structures in the brain. While the former is phase-locked, the latter is not phase-locked to the event. The most important difference between both phenomena is that the ERD/ERS is highly frequency band-specific, whereby either the same or different locations on the scalp can display ERD and ERS simultaneously. Quantification of ERD/ERS in time and space is demonstrated on data from a number of movement experiments.
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            Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research.

            This article is based on a consensus conference, which took place in Certosa di Pontignano, Siena (Italy) on March 7-9, 2008, intended to update the previous safety guidelines for the application of transcranial magnetic stimulation (TMS) in research and clinical settings. Over the past decade the scientific and medical community has had the opportunity to evaluate the safety record of research studies and clinical applications of TMS and repetitive TMS (rTMS). In these years the number of applications of conventional TMS has grown impressively, new paradigms of stimulation have been developed (e.g., patterned repetitive TMS) and technical advances have led to new device designs and to the real-time integration of TMS with electroencephalography (EEG), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI). Thousands of healthy subjects and patients with various neurological and psychiatric diseases have undergone TMS allowing a better assessment of relative risks. The occurrence of seizures (i.e., the most serious TMS-related acute adverse effect) has been extremely rare, with most of the few new cases receiving rTMS exceeding previous guidelines, often in patients under treatment with drugs which potentially lower the seizure threshold. The present updated guidelines review issues of risk and safety of conventional TMS protocols, address the undesired effects and risks of emerging TMS interventions, the applications of TMS in patients with implanted electrodes in the central nervous system, and safety aspects of TMS in neuroimaging environments. We cover recommended limits of stimulation parameters and other important precautions, monitoring of subjects, expertise of the rTMS team, and ethical issues. While all the recommendations here are expert based, they utilize published data to the extent possible.
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              Theta burst stimulation of the human motor cortex.

              It has been 30 years since the discovery that repeated electrical stimulation of neural pathways can lead to long-term potentiation in hippocampal slices. With its relevance to processes such as learning and memory, the technique has produced a vast literature on mechanisms of synaptic plasticity in animal models. To date, the most promising method for transferring these methods to humans is repetitive transcranial magnetic stimulation (rTMS), a noninvasive method of stimulating neural pathways in the brain of conscious subjects through the intact scalp. However, effects on synaptic plasticity reported are often weak, highly variable between individuals, and rarely last longer than 30 min. Here we describe a very rapid method of conditioning the human motor cortex using rTMS that produces a controllable, consistent, long-lasting, and powerful effect on motor cortex physiology and behavior after an application period of only 20-190 s.

                Author and article information

                Clin Neurophysiol
                Clin Neurophysiol
                Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology
                10 August 2017
                10 February 2015
                June 2015
                29 January 2019
                : 126
                : 6
                : 1071-1107
                [a ]Institute of Neurology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Policlinic A. Gemelli, Rome, Italy
                [b ]Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
                [c ]Division of Neurology, Toronto Western Research Institute, University of Toronto, Toronto, Ontario, Canada
                [d ]Human Cortical Physiology and Neurorehabilitation Section, NINDS, NIH, Bethesda, MD, USA
                [e ]Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
                [f ]Department of Neurology, University Campus Bio-medico, Rome, Italy
                [g ]Department of Clinical Neurophysiology, University of Eastern Finland, Kuopio, Finland
                [h ]Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred, Melbourne, Australia
                [i ]Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
                [j ]Human Motor Control Section, Medical Neurology Branch, NINDS, NIH, Bethesda, MD, USA
                [k ]Department of Physiology, Henri Mondor Hospital, Assistance Publique – Hôpitaux de Paris, Créteil, France
                [l ]EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
                [m ]Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
                [n ]Department of Neurology, Japanese Red Cross Medical Center, Tokyo, Japan
                [o ]Department of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
                [p ]IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
                [q ]Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
                [r ]Berenson-Allen Center for Non-invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
                [s ]Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany
                [t ]Brain Investigation & Neuromodulation Lab, Unit of Neurology and Clinical Neurophysiology, Department of Neuroscience, University of Siena, Siena, Italy
                [u ]Institute of Neurology, University College London, London, United Kingdom
                [v ]Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
                [w ]Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
                [x ]Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
                [y ]Institute of Cognitive Neuroscience, University College London, London, United Kingdom
                [z ]Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
                Author notes
                [* ]Corresponding author at: Institute of Neurology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Policlinic A. Gemelli, L.go A. Gemelli 8, 00168 Rome, Italy. Tel.: +39 06 3015 4279; fax: +39 06 3550 1909. r.diiorio@ (R. Di Iorio)

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