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Prospects for Clinical Applications of Transcranial Magnetic Stimulation and Real-Time EEG in Epilepsy

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Abstract

Recent advances in methods for transcranial magnetic stimulation (TMS) enable its coupling to real-time EEG (TMS-EEG). Although TMS-EEG is applied largely in neurophysiology research, there are prospects for its use in clinical TMS practice, particularly in epilepsy where EEG is already in wide use, and where TMS is emerging as a diagnostic and therapeutic tool. In diagnostic applications, TMS-EEG may provide a useful measure of cortical excitability at baseline or after antiepileptic treatment. For therapeutic purposes, TMS-EEG may be of use in selection of appropriate TMS strength outside of the motor cortex where the threshold for cortical activation is more apparent with the aid of EEG. In other realistic clinical applications, TMS-EEG may be of use in real-time monitoring for epileptiform activity in vulnerable populations where TMS may trigger seizures, or as a component of a responsive neurostimulation setup in which TMS timing is determined by underlying EEG activity. Future trials and evolution of TMS-EEG methods are likely to provide answers as to the actual clinical value of TMS-EEG.

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Acknowledgements

I thank Dr. Gregor Thut for his helpful comments in drafting this manuscript, and Drs. Frances E. Jensen and Alvaro Pascual-Leone for their contribution to ongoing experiments. The author’s work was supported by Citizens United for Research in Epilepsy (CURE) and the National Institutes of Health National Institute of Neurologic Disease and Stroke (NIH NINDS).

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  1. Department of Neurology, Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Fegan 9, Boston, MA, 02115, USA

    Alexander Rotenberg

  2. Berenson-Allen Center for Noninvasive Brain Stimulation, Harvard Medical School, Boston, MA, USA

    Alexander Rotenberg

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Correspondence to Alexander Rotenberg.

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This is one of several papers published together in Brain Topography on the “Special Topic: TMS and EEG.”

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Rotenberg, A. Prospects for Clinical Applications of Transcranial Magnetic Stimulation and Real-Time EEG in Epilepsy. Brain Topogr 22, 257–266 (2010). https://doi.org/10.1007/s10548-009-0116-3

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