Transcranial Electrical and Magnetic Stimulation

Noninvasive magnetic and electrical stimulation of cerebral cortex is an evolving field. The most widely used variant, transcranial electrical stimulation (TES), is routinely used for intraoperative monitoring. Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are emerging as clinical and experimental tools. TMS has gained wide acceptance in extraoperative functional cortical mapping. TES and TMS rely on pulsatile stimulation with electrical current intensities sufficient to trigger action potentials within the stimulated cortical volume. tDCS, in contrast, is based on neuromodulatory effects of very-low-amplitude direct current conducted through the scalp. tDCS and TMS, particularly when applied in repetitive trains, can modulate cortical excitability for prolonged periods and thus are either in active clinical use or in advanced stages of clinical trials for common neurological and psychiatric disorders such as major depression and epilepsy. This chapter summarizes physiologic principles of transcranial stimulation and clinical applications of these techniques.