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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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          Abstract

          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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          Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation.

          In this paper we demonstrate in the intact human the possibility of a non-invasive modulation of motor cortex excitability by the application of weak direct current through the scalp. Excitability changes of up to 40 %, revealed by transcranial magnetic stimulation, were accomplished and lasted for several minutes after the end of current stimulation. Excitation could be achieved selectively by anodal stimulation, and inhibition by cathodal stimulation. By varying the current intensity and duration, the strength and duration of the after-effects could be controlled. The effects were probably induced by modification of membrane polarisation. Functional alterations related to post-tetanic potentiation, short-term potentiation and processes similar to postexcitatory central inhibition are the likely candidates for the excitability changes after the end of stimulation. Transcranial electrical stimulation using weak current may thus be a promising tool to modulate cerebral excitability in a non-invasive, painless, reversible, selective and focal way.
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            Breakdown of cortical effective connectivity during sleep.

            When we fall asleep, consciousness fades yet the brain remains active. Why is this so? To investigate whether changes in cortical information transmission play a role, we used transcranial magnetic stimulation together with high-density electroencephalography and asked how the activation of one cortical area (the premotor area) is transmitted to the rest of the brain. During quiet wakefulness, an initial response (approximately 15 milliseconds) at the stimulation site was followed by a sequence of waves that moved to connected cortical areas several centimeters away. During non-rapid eye movement sleep, the initial response was stronger but was rapidly extinguished and did not propagate beyond the stimulation site. Thus, the fading of consciousness during certain stages of sleep may be related to a breakdown in cortical effective connectivity.
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              Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application. Report of an IFCN committee.

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                Author and article information

                Journal
                100883319
                21365
                Clin Neurophysiol
                Clin Neurophysiol
                Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology
                1388-2457
                1872-8952
                10 August 2017
                10 February 2015
                June 2015
                29 January 2019
                : 126
                : 6
                : 1071-1107
                Affiliations
                [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@ 123456live.it (R. Di Iorio)
                Article
                NIHMS898784
                10.1016/j.clinph.2015.02.001
                6350257
                25797650
                0749c084-b358-4ce7-aec5-b30d0f5f411e

                This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

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                Categories
                Article

                Neurology
                non-invasive stimulation,transcranial magnetic stimulation,human cortex,clinical neurophysiology,tms measures,excitability threshold

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