Opinion - (2025) Volume 11, Issue 3
Received: 01-Jun-2025, Manuscript No. elj-25-173007;
Editor assigned: 03-Jun-2025, Pre QC No. P-173007;
Reviewed: 17-Jun-2025, QC No. Q-173007;
Revised: 23-Jun-2025, Manuscript No. R-173007;
Published:
30-Jun-2025
, DOI: 10.37421/2472-0895.2025.11.327
Citation: Soler, Sophia. "TMS: Cortical Excitability, Plasticity, and Clinical Insights." Epilepsy J 11 (2025):327.
Copyright: © 2025 Soler S. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Transcranial magnetic stimulation (TMS) stands as a pivotal non-invasive tool for probing and modulating human cortical function. Recent research offers a crucial update on TMS, detailing its role in understanding cortical plasticity. It highlights how various TMS protocols induce changes in cortical excitability, which reflect synaptic and network-level modifications. The authors discuss the underlying mechanisms of these plastic changes and their implications for both basic neuroscience research and potential therapeutic applications, emphasizing methodological considerations vital for robust findings and reproducibility in the field [1].
Understanding how physiological responses to TMS change across the lifespan is essential. One paper investigates age-related differences, revealing how cortical excitability and inhibition metrics shift with age. These findings provide insight into the neurophysiological underpinnings of motor control and learning in older adults. Recognizing these differences is key for tailoring neuromodulation strategies effectively for various age groups, particularly in rehabilitation and cognitive enhancement [2].
Neurological conditions often manifest with altered cortical excitability. A systematic review and meta-analysis synthesizes findings from TMS studies to detail changes in cortical excitability following a stroke. This work offers a comprehensive overview of how motor cortex excitability is altered in stroke patients and how these changes correlate with recovery. The insights gathered contribute significantly to a better understanding of post-stroke neuroplasticity and help inform the development of targeted neuromodulatory interventions for rehabilitation [3].
Moving to other disorders, Parkinson's disease is explored concerning the relationship between altered cortical excitability and impaired motor learning. Authors examine how various forms of neuromodulation, especially TMS, reveal deficits in cortical plasticity and excitability contributing to motor symptoms. Grasping these mechanisms is crucial for developing novel therapeutic approaches aimed at enhancing motor function and learning in individuals living with Parkinson's [4].
Similarly, the state of cortical excitability in schizophrenia and its modulation using TMS and transcranial direct current stimulation (tDCS) is a focus. The findings highlight GABAergic and glutamatergic dysfunction as key elements in understanding the neurophysiological basis of the disorder. This research points to potential avenues for therapeutic interventions designed to normalize cortical circuit function [5].
The reliability and efficacy of TMS protocols themselves demand critical appraisal. A dedicated review delves into plasticity-inducing TMS protocols, examining various techniques used to modulate cortical excitability and their potential to induce lasting neuroplastic changes. This appraisal stresses the need for standardized methodologies and a deeper understanding of individual variability to enhance the translational impact of TMS in both research and clinical settings [6].
Further studies investigate specific clinical applications. Changes in cortical excitability in patients with major depressive disorder (MDD) undergoing repetitive TMS (rTMS) are explored. The findings elucidate how rTMS influences motor cortex excitability and inhibition, shedding light on the neurobiological mechanisms underlying its antidepressant effects. This work helps optimize rTMS parameters for personalized treatment strategies in MDD [7].
Chronic pain states also present with distinct alterations in cortical excitability. A systematic review synthesizes evidence from various neuromodulation studies, highlighting consistent changes in motor and somatosensory cortical function during chronic pain. Understanding these excitability shifts is crucial for identifying neurophysiological biomarkers of chronic pain and developing more effective, targeted neuromodulatory therapies [8].
Beyond pathology, fundamental aspects of learning and physiological states influence cortical excitability. One study investigates how cortical excitability changes during the acquisition of new motor skills, and how these changes are influenced by task difficulty and age. The findings provide insights into the neural mechanisms of motor learning and the age-related decline in motor plasticity, which helps in designing age-appropriate motor training paradigms and rehabilitation strategies [9].
Lastly, the impact of basic physiological states like sleep on cortical function is significant. A TMS study explores the effects of sleep deprivation on cortical excitability and plasticity. The research demonstrates how lack of sleep can significantly alter motor cortex excitability and impair the brain's capacity for plastic change. These findings underscore the critical role of adequate sleep in maintaining optimal brain function and highlight the vulnerability of neural plasticity to sleep disruption [10].
The landscape of neuroscience continually benefits from non-invasive brain stimulation techniques, with transcranial magnetic stimulation (TMS) at the forefront for exploring and modulating cortical excitability and plasticity. This collection of research provides deep insights into how TMS is employed to unravel complex brain functions and dysfunctions across various physiological and pathological states. We see a recurring emphasis on understanding the mechanisms behind cortical plasticity and how they can be harnessed for therapeutic gain [1, 6].
One significant area of focus is the impact of age and learning on cortical excitability. Research highlights how cortical excitability and inhibition metrics naturally change across the lifespan, influencing motor control and learning in older adults [2]. This age-related variability is crucial for designing effective neuromodulation and rehabilitation strategies. Complementary to this, studies investigate how cortical excitability fluctuates during the acquisition of new motor skills, with findings indicating that task difficulty and age modulate these changes. Such insights are invaluable for developing age-appropriate motor training and rehabilitation paradigms that maximize learning potential and combat age-related decline in plasticity [9].
Neurological and psychiatric disorders frequently present with distinct alterations in cortical excitability, making them prime targets for TMS-based investigations and interventions. For example, a comprehensive review of TMS studies details the specific changes in cortical excitability observed after a stroke, correlating these alterations with recovery trajectories. This body of evidence directly informs the development of targeted neuromodulatory interventions, aiming to enhance post-stroke neuroplasticity and functional recovery [3]. In Parkinson's disease, the relationship between altered cortical excitability and impaired motor learning has been extensively explored. TMS has been instrumental in revealing deficits in cortical plasticity and excitability that directly contribute to the characteristic motor symptoms, paving the way for novel therapeutic approaches to improve motor function [4]. Furthermore, the complex interplay of GABAergic and glutamatergic dysfunction underlying cortical excitability in schizophrenia is elucidated, with TMS and transcranial direct current stimulation (tDCS) showing promise for modulating these circuits and potentially normalizing brain function [5].
Beyond specific disorders, generalized conditions such as chronic pain and major depressive disorder (MDD) also involve significant changes in cortical excitability. Systematic reviews highlight consistent alterations in motor and somatosensory cortical function in chronic pain states. Understanding these excitability shifts is vital for identifying neurophysiological biomarkers and developing more precise, targeted neuromodulatory therapies to alleviate persistent pain [8]. In MDD, repetitive TMS (rTMS) has emerged as a therapeutic option, and research meticulously investigates how rTMS influences motor cortex excitability and inhibition. This helps in understanding the neurobiological mechanisms underpinning its antidepressant effects, allowing for optimization of rTMS parameters for more personalized and effective treatment strategies [7].
Crucially, even fundamental physiological states like sleep can profoundly influence cortical excitability and plasticity. One study uses TMS to demonstrate how sleep deprivation significantly alters motor cortex excitability and impairs the brain's capacity for plastic change. These findings underscore the indispensable role of adequate sleep in maintaining optimal brain function and highlight neural plasticity's vulnerability to sleep disruption [10]. The ongoing appraisal of plasticity-inducing TMS protocols underscores the necessity for standardized methodologies and a deeper grasp of individual variability. Such rigorous approaches are fundamental for enhancing the translational impact of TMS from laboratory research to meaningful clinical applications, ensuring both efficacy and reproducibility across diverse populations and conditions [1, 6]. What this really means is that while TMS offers immense potential, its application demands careful consideration of both the underlying neurophysiology and the methodological rigor of its use.
This body of research offers a comprehensive look at transcranial magnetic stimulation (TMS) and its profound implications for understanding human cortical plasticity and excitability. A crucial update highlights how diverse TMS protocols induce changes in cortical excitability, reflecting modifications at synaptic and network levels, with significant implications for basic neuroscience and therapeutic applications. Here, we see emphasis on methodological considerations for robust and reproducible findings. Studies further explore how cortical excitability and inhibition metrics evolve across the lifespan, providing key insights into age-related differences in motor control and learning, which are vital for tailoring neuromodulation strategies in older adults. The impact of neurological conditions on cortical excitability is a recurring theme. A systematic review synthesizes findings on changes in excitability after stroke, correlating these alterations with recovery and informing targeted rehabilitation interventions. In Parkinson's disease, altered cortical excitability and impaired motor learning are examined, revealing deficits in cortical plasticity that contribute to motor symptoms. This understanding is key for developing new therapies. Similarly, research delves into cortical excitability in schizophrenia, highlighting GABAergic and glutamatergic dysfunction and suggesting therapeutic avenues using TMS and transcranial direct current stimulation (tDCS) to normalize circuit function. We also explore the efficacy of plasticity-inducing TMS protocols, underscoring the need for standardized methodologies and a deeper understanding of individual variability to enhance translational impact. Cortical excitability changes are investigated in major depressive disorder (MDD) during repetitive TMS, elucidating mechanisms behind its antidepressant effects and informing personalized treatment. Chronic pain states are linked to alterations in cortical excitability, providing potential neurophysiological biomarkers for targeted therapies. Furthermore, the acquisition of new motor skills influences cortical excitability, modulated by task difficulty and age, guiding age-appropriate motor training. Finally, sleep deprivation significantly alters cortical excitability and impairs plasticity, emphasizing sleep's role in optimal brain function. This collection paints a picture of TMS as an invaluable tool for both diagnosing and treating various neurological and psychiatric conditions.
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