Diagnostic utility of transcranial magnetic stimulation for neurodegenerative disease: a critical review

Moreno-Roco, Javier; Valle, Lucía del; Jiménez, Daniel; Acosta, Ignacio; Castillo, José Luis; Dharmadasa, Thanuja; Kiernan, Matthew C.; Matamala, José Manuel

doi:10.1590/1980-5764-DN-2023-0048

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Dementia & Neuropsychologia

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View and Review • Dement. neuropsychol. 17 • 2023 • https://doi.org/10.1590/1980-5764-DN-2023-0048 copy

Diagnostic utility of transcranial magnetic stimulation for neurodegenerative disease: a critical review

Utilidade diagnóstica da estimulação magnética transcraniana para doenças neurodegenerativas: uma revisão crítica

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT.

Neurodegenerative diseases pose significant challenges due to their impact on brain structure, function, and cognition. As life expectancy rises, the prevalence of these disorders is rapidly increasing, resulting in substantial personal, familial, and societal burdens. Efforts have been made to optimize the diagnostic and therapeutic processes, primarily focusing on clinical, cognitive, and imaging characterization. However, the emergence of non-invasive brain stimulation techniques, specifically transcranial magnetic stimulation (TMS), offers unique functional insights and diagnostic potential. TMS allows direct evaluation of brain function, providing valuable information inaccessible through other methods. This review aims to summarize the current and potential diagnostic utility of TMS in investigating neurodegenerative diseases, highlighting its relevance to the field of cognitive neuroscience. The findings presented herein contribute to the growing body of research focused on improving our understanding and management of these debilitating conditions, particularly in regions with limited resources and a pressing need for innovative approaches.

Keywords:
Transcranial Magnetic Stimulation; Neurophysiology; Biomarkers; Neurodegenerative Diseases; Amyotrophic Lateral Sclerosis

Protocols		Proposed physiological mechanisms	Neurotransmitters involved
Single-Pulse TMS	MEP	Summation of corticospinal volleys of direct and indirect waves onto corticospinal neurons. Global excitability	Mainly glutamatergic synapses through corticomotoneuronal system
	RMT	Density of corticomotoneuronal projections and their global excitability	Mainly glutamatergic synapses through corticomotoneuronal system
	CSP	Cortico-subcortical and spinal excitability	Mainly GABA_B-type receptors
	ISP	Evaluate transcallosal inhibition	Glutamatergic and GABAergic synapses
	CMCT	Excitability of the fastest conducting corticomotoneuronal projections	Mainly glutamatergic synapses through corticomotoneuronal system
Paired-Pulse TMS	SICI	Inhibitory short-interval intracortical circuits	GABA_A-type receptors mediated
	ICF	Facilitatory short-interval intracortical circuits	Glutamatergic excitatory postsynaptic potentials (NMDA receptor)
	SICF	Facilitatory short-interval intracortical circuits	Facilitatory activity from interneuronal activation resulting in summation of I-waves on corticospinal neurons
	LICI	Inhibitory long-interval intracortical circuits	Mediated in part by GABA_B-type receptors
	SAI	Motor cortex inhibition induced by short-latency peripheral afferents stimulus	Cholinergic thalamocortical projections on GABA_A cortical networks
	LAI	Motor cortex inhibition induced by long-latency peripheral afferents stimulus	Inhibitory interneurons that are shared by LICI
	CBI	Inhibitory dento-thalamo-cortical pathway	GABA_A receptors at the end of cerebellothalamocortical pathway
Neuro-plasticity TMS	iTBS	Corticospinal or corticocortical excitability that may reflect LTP-like synaptic effects	Glutamatergic NMDA receptors mediating LTP-like synaptic effects
	cTBS	As iTBS, but may reflect LTD-like synaptic effects	May mediate LTD-like synaptic effects by GABAergic transmission
	HF rTMS	LTP-like synaptic effects	May mediate LTD-like effects through slow increase in ionic calcium concentration
	LF rTMS	LTD-like synaptic effects	May mediate reduce cortical excitability generating later I-waves
	PAS	LTP-like effects through Hebbian STDP	Mainly glutamatergic NMDA receptors mediating LTP-like effects

Protocol	Single- pulse protocols					Paired pulse protocols							Neuroplasticity protocols
Disease	MEP	RMT	CSP	ISP	CMCT	SICI	ICF	SICF	LICI	SAI	LAI	CBI	iTBS	cTBS	HF TMS	LF TMS	PAS
ALS	↑	↓	↓		↑	↓	^* * controversial results in the literature; blank cell, no data available in the literature to date.	↑		↓	↓						↓
AD	↑	↓	↓	↑	=	↓	=		↓	↓							↓
FTD	↓	↑	↓		↑	↓	↓		↓	^* * controversial results in the literature; blank cell, no data available in the literature to date.			^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.			↓
PD	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	^* * controversial results in the literature; blank cell, no data available in the literature to date.	↓	↓	↓				^* * controversial results in the literature; blank cell, no data available in the literature to date.

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Correspondence: José Manuel Matamala; Email: jm_matamala@med.uchile.cl.