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Application of Transcranial Magnetic Stimulation (TMS) in Motor Control and Learning

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A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurotechnology and Neuroimaging".

Deadline for manuscript submissions: closed (20 November 2025) | Viewed by 5753

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Special Issue Editor

Dr. Sean K. Meehan

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Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
Interests: sensorimotor neuroscience; motor learning and adaptation; transcranial magnetic stimulation; human neurophysiology; concussion; stroke recovery

Special Issue Information

Dear Colleagues,

TMS provides a non-invasive method to induce neural activity in the human brain that can be used to assess or modulate the underlying cortical mechanisms governing motor control and learning. Single and paired-pulse assessments, including dual-site TMS, assess how corticospinal projections, intracortical circuits, and corticocortical or cerebellar-cortical loops shape motor control and change with learning. Repetitive TMS protocols probe mechanisms of neuroplasticity and offer the potential to enhance clinical approaches to movement disorders.

This Special Issue seeks to assemble original research and review papers highlighting the novel application of conventional approaches and emerging TMS technologies to our understanding of motor control and learning. Basic and clinical studies investigating the role of intra- and intercortical mechanisms in the brain–behavior relationship or those seeking to exploit mechanistic knowledge to enhance motor ability are particularly encouraged. Studies examining the neurophysiological mechanisms targeted by TMS methodologies, including controllable pulse parameter TMS, are also encouraged.

Dr. Sean Meehan
Guest Editor

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Keywords

transcranial magnetic stimulation
non-invasive
motor
sensorimotor
intracortical
neuroplasticity
basic neuroscience
clinical neuroscience
dual-site TMS

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Published Papers (5 papers)

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Research

Jump to: Review, Other

18 pages, 1722 KB

Open AccessArticle

Mixed-Frequency rTMS Rapidly Modulates Multiscale EEG Biomarkers of Excitation–Inhibition Balance in Autism Spectrum Disorder: A Single-Case Report

by Alptekin Aydin, Ali Yildirim, Olga Kara and Zachary Mwenda

Brain Sci. 2025, 15(12), 1269; https://doi.org/10.3390/brainsci15121269 - 26 Nov 2025

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Abstract

Background: Repetitive transcranial magnetic stimulation (rTMS) is an established neuromodulatory method, yet its multiscale neurophysiological effects in autism spectrum disorder (ASD) remain insufficiently characterized. Recent EEG analytic advances—such as spectral parameterization, long-range temporal correlation (LRTC) assessment, and connectivity modeling—enable quantitative evaluation of excitation–inhibition (E/I) balance and network organization. Objective: This study aimed to examine whether an eight-session, EEG-guided mixed-frequency rTMS protocol—combining inhibitory 1 Hz and excitatory 10 Hz trains individualized to quantitative EEG (qEEG) abnormalities—produces measurable changes in spectral dynamics, temporal correlations, and functional connectivity in a pediatric ASD case. Methods: An 11-year-old right-handed female with ASD (DSM-5-TR, ADOS-2) underwent resting-state EEG one week before and four months after intervention. Preprocessing used a validated automated pipeline, followed by spectral parameterization (FOOOF), detrended fluctuation analysis (DFA), and connectivity analyses (phase-lag index and Granger causality) in MATLAB (2023b). No inferential statistics were applied due to the single-case design. The study was conducted at Cosmos Healthcare (London, UK) with in-kind institutional support and approved by the Atlantic International University IRB (AIU-IRB-22-101). Results: Post-rTMS EEG showed (i) increased delta and reduced theta/alpha/beta power over central regions; (ii) steeper aperiodic slope and higher offset, maximal at Cz, suggesting increased inhibitory tone; (iii) reduced Hurst exponents (1–10 Hz) at Fz, Cz, and Pz, indicating decreased long-range temporal correlations; (iv) reorganization of hubs away from midline with marked Cz decoupling; and (v) strengthened parietal-to-central directional connectivity (Pz→Cz) with reduced Cz→Pz influence. Conclusions: Mixed-frequency, EEG-guided rTMS produced convergent changes across spectral, aperiodic, temporal, and connectivity measures consistent with modulation of cortical E/I balance and network organization. Findings are preliminary and hypothesis-generating. The study was supported by in-kind resources from Cosmos Healthcare, whose authors participated as investigators but had no influence on analysis or interpretation. Controlled trials are warranted to validate these exploratory results. Full article

(This article belongs to the Special Issue Application of Transcranial Magnetic Stimulation (TMS) in Motor Control and Learning)

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19 pages, 966 KB

Open AccessArticle

Sensitivity to Instruction Strategies in Motor Learning Is Predicted by Anterior–Posterior TMS Motor Thresholds

by Michael L. Perrier, Kylee R. Graham, Jessica E. Vander Vaart, W. Richard Staines and Sean K. Meehan

Brain Sci. 2025, 15(6), 645; https://doi.org/10.3390/brainsci15060645 - 16 Jun 2025

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Abstract

Background: The impact of exogenous explicit knowledge on early motor learning is highly variable and may be influenced by excitability within the procedural sensorimotor network. Recent transcranial magnetic stimulation (TMS) studies suggest that variability in interneuron recruitment by anterior–posterior (AP) currents is linked to differences in functional connectivity between premotor and motor regions. Objectives: This study used controllable pulse parameter TMS (cTMS) to assess how AP-sensitive interneuron excitability interacts with explicit knowledge to influence motor learning. Methods: Seventy-two participants were grouped as AP-positive (n = 36) and AP-negative groups (n = 36) based on whether an AP threshold could be obtained before reaching maximal stimulator output. A narrow (30 µs) stimulus was employed to target the longest latency corticospinal inputs selectively. Participants then practiced a continuous visuomotor tracking task and completed a delayed retention test. Half of each group received explicit knowledge of a repeated sequence embedded between random sequences. Random sequence tracking performance assessed general sensorimotor efficiency; repeated sequence performance assessed sequence-specific learning. Results: Both AP₃₀-positive participants, with and without explicit knowledge, and the AP₃₀-negative without explicit knowledge demonstrated similar improvements in sensorimotor efficiency driven by offline consolidation. However, AP₃₀-negative participants given explicit instruction exhibited significantly reduced improvement in sensorimotor efficiency, primarily due to impaired offline consolidation. Conclusions: These findings suggest that individuals with low excitability in long-latency AP-sensitive inputs may be more vulnerable to interference from explicit instruction. The current results highlight the importance of accounting for individual differences in interneuron excitability when developing instructional strategies for motor learning. Full article

(This article belongs to the Special Issue Application of Transcranial Magnetic Stimulation (TMS) in Motor Control and Learning)

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Review

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37 pages, 1276 KB

Open AccessReview

Versatility of Transcranial Magnetic Stimulation: A Review of Diagnostic and Therapeutic Applications

by Massimo Pascuzzi, Nika Naeini, Adam Dorich, Marco D’Angelo, Jiwon Kim, Jean-Francois Nankoo, Naaz Desai and Robert Chen

Brain Sci. 2026, 16(1), 101; https://doi.org/10.3390/brainsci16010101 - 17 Jan 2026

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Abstract

Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation technique that utilizes magnetic fields to induce cortical electric currents, enabling both the measurement and modulation of neuronal activity. Initially developed as a diagnostic tool, TMS now serves dual roles in clinical neurology, offering insight into neurophysiological dysfunctions and the therapeutic modulation of abnormal cortical excitability. This review examines key TMS outcome measures, including motor thresholds (MT), input–output (I/O) curves, cortical silent periods (CSP), and paired-pulse paradigms such as short-interval intracortical inhibition (SICI), short-interval intracortical facilitation (SICF), intracortical facilitation (ICF), long interval cortical inhibition (LICI), interhemispheric inhibition (IHI), and short-latency afferent inhibition (SAI). These biomarkers reflect underlying neurotransmitter systems and can aid in differentiating neurological conditions. Diagnostic applications of TMS are explored in Parkinson’s disease (PD), dystonia, essential tremor (ET), Alzheimer’s disease (AD), and mild cognitive impairment (MCI). Each condition displays characteristic neurophysiological profiles, highlighting the potential for TMS-derived biomarkers in early or differential diagnosis. Therapeutically, repetitive TMS (rTMS) has shown promise in modulating cortical circuits and improving motor and cognitive symptoms. High- and low-frequency stimulation protocols have demonstrated efficacy in PD, dystonia, ET, AD, and MCI, targeting the specific cortical regions implicated in each disorder. Moreover, the successful application of TMS in differentiating and treating AD and MCI underscores its clinical utility and translational potential across all neurodegenerative conditions. As research advances, increased attention and investment in TMS could facilitate similar diagnostic and therapeutic breakthroughs for other neurological disorders that currently lack robust tools for early detection and effective intervention. Moreover, this review also aims to underscore the importance of maintaining standardized TMS protocols. By highlighting inconsistencies and variability in outcomes across studies, we emphasize that careful methodological design is critical for ensuring the reproducibility, comparability, and reliable interpretation of TMS findings. In summary, this review emphasizes the value of TMS as a distinctive, non-invasive approach to probing brain function and highlights its considerable promise as both a diagnostic and therapeutic modality in neurology—roles that are often considered separately. Full article

(This article belongs to the Special Issue Application of Transcranial Magnetic Stimulation (TMS) in Motor Control and Learning)

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Other

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13 pages, 1086 KB

Open AccessCase Report

Balance Training-Related Changes in Intracortical Inhibition and Symptom Severity in a Patient with Chronic Neuropathic Pain: A Single-Case Study

by Wolfgang Taube, Naima Mory, Franziska Peier, Michael Mouthon, Joelle N. Chabwine and Benedikt Lauber

Brain Sci. 2026, 16(2), 203; https://doi.org/10.3390/brainsci16020203 - 9 Feb 2026

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Abstract

Background/Objectives: It is widely recognized that malfunctions in the GABAergic system can be one of the underlying mechanisms in chronic pain. However, the use of GABAergic drugs to improve pain perception has strong and unwanted side effects, particularly in terms of sedation. Therefore, the present exploratory single-case study tested an alternative treatment using balance training to upregulate the GABAergic system in a 62-year-old patient with widespread chronic pain. Previously, balance training was shown to increase short-interval intracortical inhibition (SICI), a neurophysiological marker commonly associated with GABA-mediated intracortical inhibition, as assessed using paired-pulse transcranial magnetic stimulation (TMS), in healthy young and older adults. Therefore, we hypothesized that the balance-training-induced increase in GABA_A-related intracortical inhibition would alleviate pain and increase quality of life. Methods: After two baseline measures, the patient participated in two balance training periods of 4 weeks each, followed by two detraining phases of 2 months each. At baseline and after each intervention and each detraining, intracortical inhibition (i.e., SICI) as well as pain and ‘well-being’ (questionnaires) was assessed. Results: Our results demonstrated enhanced and better modulated intracortical inhibition after 4 weeks of balance training, which was in line with analgesia and improved sleep and mood scores. However, after the first detraining, all parameters went back to baseline. In a subsequent second period of 4 weeks of balance training, intracortical inhibition was again increased, even above the values of the first training period. Pain, sleep, and mood scores were also further improved. After the second detraining period, all values dropped back close to their baseline values. Conclusions: The findings support the assumption that the GABAergic system is highly relevant in the processing and perception of pain. More importantly, our results suggest the possibility that balance training may be an effective way not only to upregulate intracortical inhibition but also to alleviate pain and improve well-being in patients with unspecific chronic pain. Full article

(This article belongs to the Special Issue Application of Transcranial Magnetic Stimulation (TMS) in Motor Control and Learning)

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13 pages, 825 KB

Open AccessSystematic Review

Effects of Navigated rTMS on Post-Stroke Upper-Limb Function: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Jungwoo Shim and Changju Kim

Brain Sci. 2025, 15(11), 1247; https://doi.org/10.3390/brainsci15111247 - 20 Nov 2025

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Abstract

Objectives: Neuronavigation may improve the precision and reproducibility of repetitive transcranial magnetic stimulation (rTMS) by aligning stimulation with individualized targets. Whether navigation-guided rTMS benefits post-stroke upper-limb recovery is unclear. We conducted a PRISMA-compliant systematic review and meta-analysis to estimate the effect of navigated rTMS, added to standard rehabilitation, versus sham. Methods: The protocol was registered in PROSPERO (CRD420251165052). Two reviewers independently searched CENTRAL, MEDLINE, Embase, CINAHL, Web of Science, and Google Scholar (October 2025), screened records, extracted data, and assessed risk of bias (Cochrane RoB-1). The prespecified primary endpoint was changed in Fugl–Meyer Assessment of the upper extremity (FMA-UE) from baseline to end of treatment. Effects were pooled as mean differences under random-effects models. When change-score standard deviations (SDs) were unavailable, they were derived from pre/post SDs assuming within-person correlation r = 0.5; sensitivity analyses used r = 0.7 and r = 0.9. Multi-arm trials were combined to avoid double counting. Results: four randomized, sham-controlled trials (n = 297) contributed end-of-treatment change in FMA-UE. The pooled effect favored navigated rTMS but was not statistically significant (MD 3.65, 95% CI −1.84 to 9.13; I² = 73%). Sensitivity analyses with higher r produced directionally consistent estimates. A subgroup of 2-week (10-session) protocols (k = 3) showed a significant benefit (MD 7.09, 95% CI 4.14 to 10.05; I² = 0%). Most risk-of-bias domains were low risk. Conclusions: Navigated rTMS did not show a consistent short-term advantage over sham on FMA-UE across heterogeneous protocols. A positive signal in standardized 2-week courses supports further adequately powered multicenter randomized controlled trials (RCTs) with harmonized protocols and complete variance reporting. Full article

(This article belongs to the Special Issue Application of Transcranial Magnetic Stimulation (TMS) in Motor Control and Learning)

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