Transcranial Magnetic Stimulation Experiments Research Articles

Exploring the Influence of Inter-Trial Interval on the Assessment of Short-Interval Intracortical Inhibition.

Short-interval intracortical inhibition (SICI) is a common paired-pulse transcranial magnetic stimulation (TMS) measure used to assess primary motor cortex (M1) interneuron activity in healthy populations and in neurological disorders. Many of the parameters of TMS stimulation to most accurately measure SICI have been determined. However, one TMS parameter that has not been investigated is the time between SICI trials (termed inter-trial interval; ITI). This is despite a series of single-pulse TMS studies which have reported that motor evoked potential (MEP) amplitude were suppressed for short, but not long ITIs in approximately the initial ten trials of a TMS block of 20-30 trials. The primary purpose was to examine the effects of ITI on the quantification of SICI at rest. A total of 23 healthy adults completed an experimental session that included four SICI trial blocks. Each block utilized a different ITI (4, 6, 8, and 10 s) and was comprised of a total of 26 SICI trials divided into three epochs. ANOVA revealed that the main effects for ITI and epoch as well as their interaction were all non-statistically significant for SICI. We conclude that the shorter (4-6 s) ITIs used in studies investigating SICI should not alter the interpretation of M1 activity, while having the advantages of being more comfortable to participants and reducing the experimental time needed to evaluate perform single and paired-pulse TMS experiments.

Instrumentation for TMS‐EEG Experiment: ArTGen and a Custom EEG Interface

ABSTRACTIn transcranial magnetic stimulation (TMS) and electroencephalography (EEG) experiments, two researchers typically collaborate in the lab. This study addresses the challenge a single researcher faces in managing the TMS experiment's timing while operating the TMS coil. It introduces the Arduino Trigger Generator (ArTGen) to remotely control the timing of TMS experiments using a footswitch pedal. Moreover, a bespoke printed circuit board (PCB) is designed to interface the eegoMylab amplifier with off‐the‐shelf EEG caps. The ArTGen facilitates accurate timing of the TMS stimulator's inter‐pulse intervals (IPIs) through a footswitch pedal, enhancing researchers' control over TMS‐EEG experiments. The PCB interface provides a cost‐effective tool to extend the functionality of the eegoMylab amplifier. The integration of our PCB interface has been validated in a custom TMS‐EEG setup by analyzing TMS‐evoked potentials (TEPs), global mean field power (GMFP), butterfly plots, and event‐related spectral potentials (ERSPs). The PCB reliably preserved EEG signal integrity, ensuring accurate data acquisition. Thorough channel‐wise consistency checks across components confirmed data accuracy. ArTGen's portability and footswitch feature streamline experimental control, aiding TMS‐EEG research and clinical applications. Moreover, our PCB resolves compatibility between the eegoMylab amplifier and the Waveguard EEG cap by extending the amplifier to connect to off‐the‐shelf EEG caps. The ArTGen serves as a robust remote control tool for TMS stimulators, while our PCB interface presents a solution for integrating a customized TMS‐EEG setup. This study addresses the gap in existing TMS‐EEG research by introducing innovative technological enhancements that not only augment experimental flexibility but also streamline procedural workflows.

The causal involvement of the visual cortex in visual working memory remains uncertain.

The role of the early visual cortex in visual working memory (VWM) is a matter of current debate. Neuroimaging studies have consistently shown that visual areas encode the content of working memory, while transcranial magnetic stimulation (TMS) studies have presented incongruent results. Thus, we lack conclusive evidence supporting the causal role of early visual areas in VWM. In a recent registered report, Phylactou et al. (Phylactou P, Shimi A, Konstantinou N 2023 R. Soc. Open Sci. 10, 230321 (doi:10.1098/rsos.230321)) sought to tackle this controversy via two well-powered TMS experiments, designed to correct possible methodological issues of previous attempts identified in a preceding systematic review and meta-analysis (Phylactou P, Traikapi A, Papadatou-Pastou M, Konstantinou N 2022 Psychon. Bull. Rev. 29, 1594-1624 (doi:10.3758/s13423-022-02107-y)). However, a key part of their critique and experimental design was based on a misunderstanding of the visual system. They disregarded two important anatomical facts, namely that early visual areas of each hemisphere represent the contralateral visual hemifield, and that each hemisphere receives equally strong input from each eye-both leading to confounded conditions and artefactual effects in their studies. Here, we explain the correct anatomy, describe why their experiments failed to address current issues in the literature and perform a thorough reanalysis of their TMS data revealing important null results. We conclude that the causal role of the visual cortex in VWM remains uncertain.

In-vivo verified anatomically aware deep learning for real-time electric field simulation

Objective. Transcranial magnetic stimulation (TMS) has emerged as a prominent non-invasive technique for modulating brain function and treating mental disorders. By generating a high-precision magnetically evoked electric field (E-field) using a TMS coil, it enables targeted stimulation of specific brain regions. However, current computational methods employed for E-field simulations necessitate extensive preprocessing and simulation time, limiting their fast applications in the determining the optimal coil placement. Approach. We present an attentional deep learning network to simulate E-fields. This network takes individual magnetic resonance images and coil configurations as inputs, firstly transforming the images into explicit brain tissues and subsequently generating the local E-field distribution near the target brain region. Main results. Relative to the previous deep-learning simulation method, the presented method reduced the mean relative error in simulated E-field strength of gray matter by 21.1%, and increased the correlation between regional E-field strengths and corresponding electrophysiological responses by 35.0% when applied into another dataset. In-vivo TMS experiments further revealed that the optimal coil placements derived from presented method exhibit comparable stimulation performance on motor evoked potentials to those obtained using computational methods. The simplified preprocessing and increased simulation efficiency result in a significant reduction in the overall time cost of traditional TMS coil placement optimization, from several hours to mere minutes. Significance. The precision and efficiency of presented simulation method hold promise for its application in determining individualized coil placements in clinical practice, paving the way for personalized TMS treatments.

Functional specificity of the left ventrolateral prefrontal cortex in positive reappraisal: A single-pulse transcranial magnetic stimulation study

Neuroimage studies have yielded evidence for a correlation between the left ventrolateral prefrontal cortex (VLPFC) and a specific type of cognitive reappraisal strategy, positive reappraisal. However, evidence is still lacking for a direct relation. We used single-pulse transcranial magnetic stimulation (TMS) over the left VLPFC at different time points to investigate the functional specificity of the left VLPFC in the success of positive reappraisal and the timing at which the left VLPC was involved in positive reappraisal. Fifteen participants engaged in a baseline experiment and in TMS experiments. All participants successfully reduced their negative emotional ratings using positive reappraisal in the baseline experiment. In the TMS experiments, participants performed the same task as in the baseline experiment but single-pulse TMS was applied over the left VLPFC at 300 ms or/and 3,300 ms after stimulus onset, as well as over the vertex as a control stimulation. Valence ratings of negative stimuli increased (unpleasantness reduction) when participants reappraised negative stimuli with TMS stimulation over the left VLPFC, regardless of the timing of the stimulation at 300 ms or/and at 3,300 ms after the stimulus onset, relative to the vertex stimulation and the baseline experiment. Our study provided evidence of the functional specificity of the left VLPFC in regulation of negative emotions using positive reappraisal. The left VLPFC was believed to be involved in different stages of positive reappraisal. The prominent facilitation effect of TMS over the left VLPFC makes it possible to consider potential applications in clinical practice for mood disorders.

A New Theory for Ball Lightning Proposed: Aberrant Cellular Dust Discharges [Aerial Extra Corpuscular “Epilepsy”

According to the Cellular Dust Hypothesis, CDH [1-2] and Seun Ayoade’s Law of Living Things, S.A.L.L.T. [3] life and the universe exist due to chemical reactions carried out by ubiquitous virus sized entities variously called microzymas, cellular dust, scintillating corpuscles, molecular granulations, progenitor cryptocides, siphonospora polymorpha etc. [4] These imperishable micro entities have been hypothesized to be linked to dark matter, dark energy, phantom pain and spontaneous human combustion [5-7] but could they also be responsible for ball lightning? Theories attempting to explain ball lightning include: the Vaporized silicon hypothesis, the Electrically charged solid-core model, the Microwave cavity hypothesis, the Soliton hypothesis, Hydrodynamic vortex ring antisymmetry, the Nanobattery hypothesis, the Buoyant plasma hypothesis, Spinning plasma toroid, the Vacuum hypothesis, the Spinning electric dipole hypothesis and plasma superconductivity. However the Transcranial magnetic stimulation experiments by The Coorays [8] showed that epileptics having seizures see ball lightning during their hallucinations!

A New Theory for Ball Lightning Proposed: Aberrant Cellular Dust Discharges [Aerial Extra Corpuscular “Epilepsy”

According to the Cellular Dust Hypothesis, CDH [1-2] and Seun Ayoade’s Law of Living Things, S.A.L.L.T. [3] life and the universe exist due to chemical reactions carried out by ubiquitous virus sized entities variously called microzymas, cellular dust, scintillating corpuscles, molecular granulations, progenitor cryptocides, siphonospora polymorpha etc. [4] These imperishable micro entities have been hypothesized to be linked to dark matter, dark energy, phantom pain and spontaneous human combustion [5-7] but could they also be responsible for ball lightning? Theories attempting to explain ball lightning include: the Vaporized silicon hypothesis, the Electrically charged solid-core model, the Microwave cavity hypothesis, the Soliton hypothesis, Hydrodynamic vortex ring antisymmetry, the Nanobattery hypothesis, the Buoyant plasma hypothesis, Spinning plasma toroid, the Vacuum hypothesis, the Spinning electric dipole hypothesis and plasma superconductivity. However the Transcranial magnetic stimulation experiments by The Coorays [8] showed that epileptics having seizures see ball lightning during their hallucinations!

Expected TMS excites the motor system less effectively than unexpected stimulation

The brain's response to sensory input is modulated by prediction. For example, sounds that are produced by one's own actions, or those that are strongly predicted by environmental cues, elicit an attenuated N1 component in the auditory evoked potential. It has been suggested that this form of sensory attenuation to stimulation produced by one's own actions is the reason we are unable to tickle ourselves. Here we examined whether the neural response to direct stimulation of the brain is attenuated by prediction in a similar manner. Transcranial magnetic stimulation (TMS) applied over primary motor cortex can be used to gauge the excitability of the motor system. Motor-evoked potentials (MEPs), elicited by TMS and measured in peripheral muscles, are larger when actions are being prepared and smaller when actions are voluntarily suppressed. We tested whether the amplitude of MEPs was attenuated under circumstances where the TMS pulse can be reliably predicted, even though control of the relevant motor effector was never required. Self-initiation of the TMS pulse and reliable cuing of the TMS pulse both produced attenuated MEP amplitudes, compared to those generated programmatically in an unpredictable manner. These results suggest that predictive coding may be governed by domain-general mechanisms responsible for all forms predictive learning. The findings also have important methodological implications for designing TMS experiments that control for the predictability of TMS pulses.

Design of coils for lateralized TMS on mice

Objective. Translational studies on animals play a vital role in the advancement of transcranial magnetic stimulation (TMS) as clinical technique. Nonetheless the relevance of these procedures is frequently limited by the lack of TMS systems specifically designed for small animals capable of producing comparable stimulation conditions to those found in human TMS. In this work, we propose to take advantage of the versatility of recently introduced TMS coil design methods to produce optimal rodent-specific TMS stimulators. Approach. A stream function inverse boundary element method (IBEM) has been used for producing three small sized mice-specific TMS coils of different geometries. They have been created for unilateral hemispheric stimulation of the rodent brain, and several constraints have been considered in the design process to satisfy essential performance requirements, such as minimum stored magnetic energy, minimum power dissipation, optimised maximum current density or minimization of the undesired electric field induced in non-target regions. In order to validate the presented strategy, three prototype coils have been built. The performance of each prototype has also been numerically investigated, where the electric field induced in a mouse model has been found by using an existing computational forward technique. Main results. Stream function IBEM represents an ideally suited approach for designing specific TMS coils for small animals, capable of fulfilling many essential functional and technical requirements. The prototypes produced in this work focally stimulate the right hemisphere of the mouse brain, and so they can be successfully used in lateralized TMS experiments. Significance. The design scheme proposed here can be used to produce efficient TMS stimulators for small animals, which can overcome some of the existing limitations found when producing more reliable translational experiments.

Speech Perception Triggers Articulatory Action: Evidence From Mechanical Stimulation

Neuroimaging studies show that the brain articulatory motor system is activated during speech perception. These results, however, cannot determine whether the motor system is engaged in motor simulation (e.g., lip movement) or in non-motor computations. To gauge the causal role of the articulatory motor system, here we examine the effect of mechanical stimulation. Participants heard speech tokens, ambiguous with respect to voicing—either labial (ba/pa) or coronal (da/ta)—while lightly biting on either the lips or tongue. Compared to incongruent stimulation (e.g., lips, with da/ta), congruent stimulation (e.g., tongue, with da/ta) shifted the voicing percepts and improved discrimination sensitivity (d’). Results are the first to demonstrate that adults engage the articulatory motor system in speech perception even when it is irrelevant to response. The convergence with transcranial magnetic stimulation experiments demonstrates that speech perception engages articulatory action. These conclusions illuminate the links between embodiment and cognition.

Do nociceptive stimulation intensity and temporal predictability influence pain-induced corticospinal excitability modulation?

Temporal predictability and intensity of an impending nociceptive input both shape pain experience and modulate laser-evoked potentials (LEPs) amplitude. However, it remains unclear whether and how these two factors could influence pain-induced corticospinal excitability modulation. The current study investigated the influence of nociceptive stimulation intensity and temporal predictability on motor-evoked potentials (MEPs) modulation, in parallel to their effect on pain perception and LEPs amplitude. Twenty participants completed electroencephalographic and transcranial magnetic stimulation experiments during which two laser nociceptive stimulation intensities (high and low) were either unpredictably delivered (random delay) or preceded by a fixed-timing cue (fixed delay). The amplitude of the conditioned MEPs was significantly reduced only for the high nociceptive stimulation and was not affected by the temporal predictability of pain (despite the fact that temporal predictability modulated the amplitude of P2 LEP component amplitude). However, a posteriori analyses based on patterns of pain-induced MEPs modulation revealed that participants in which nociceptive stimulation resulted in an increase in corticospinal excitability were more affected by the predictability of pain (i.e. increasing corticospinal excitability even more when pain occurrence was predictable), regardless of the nociceptive stimulation intensity; whereas participants in which nociceptive stimulation resulted in a decrease in corticospinal excitability were sensitive to the intensity of the stimulation but not its predictability. These results suggest a potential influence of cognitive factors such as temporal predictability on the response of the motor system in the presence of pain for some participants, contributing to explain, at least in part, the high variability highlighted in a number of previous studies.

More subjects are required for ventrolateral than dorsolateral prefrontal TMS because of intolerability and potential drop-out.

Transcranial magnetic stimulation (TMS) of the human lateral prefrontal cortex, particularly the ventral region, often causes considerable discomfort to subjects. To date, in contrast to abundant literature on stimulations to the dorsolateral prefrontal cortex, the ventrolateral prefrontal cortex has been less frequently stimulated, partly because some subjects are intolerable of stimulation to the ventrolateral prefrontal cortex. To predict the additional number of subjects required for the stimulation of the dorsolateral and ventrolateral prefrontal cortices, 20 young healthy subjects reported two evaluation scores: the discomfort caused by TMS and the resulting intolerability to complete the TMS experiments. Single-pulse stimulation (SPS) or theta-burst stimulation (TBS) was administered to the lateral prefrontal cortex. The high-resolution extended 10–20 system was used to provide accurate estimation of the voxelwise scores. The discomfort ratings with the SPS and TBS were relatively higher in the ventrolateral prefrontal cortex than those in the dorsolateral prefrontal cortex. Both the SPS and TBS elicited maximal discomfort at the stimulation position F8. The SPS and TBS to F8 under the standard TMS protocols were intolerable for approximately one half (11 and 10, respectively) of the subjects. The intolerability was further calculated for all voxels in the lateral prefrontal cortex, which enabled us to estimate the additional number of subjects required for specific target areas. These results suggest that prior knowledge of subjects’ discomfort during stimulation of the lateral prefrontal cortex can be of practical use in the experimental planning of the appropriate number of recruited subjects and provide the database for the probability of intolerability that can be used to predict the additional number of subjects.

A multi-scale computational approach based on TMS experiments for the assessment of electro-stimulation thresholds of the brain at intermediate frequencies

In recent years, human exposure to electromagnetic fields (EMF) at intermediate frequencies (300 Hz–10 MHz) has risen, mainly due to the growth of technologies using these fields. The current safety guidelines/standards defined by international bodies (e.g. ICNIRP and IEEE) established basic restrictions for limiting EMF exposure. These limits at intermediate frequencies are derived from threshold values of the internal electric field that may produce transient effects, such as the stimulation of the nervous system. However, there are some discrepancies between the basic restrictions of those guidelines/standards. The aim of this study is to investigate the excitation thresholds of the nervous system exposed to intermediate-frequency electromagnetic fields, with the purpose of extrapolating the threshold-frequency curves which are compared with existing basic restrictions prescribed by the international guidelines/standards. Our investigation was based on transcranial magnetic stimulation (TMS) experiments, physiological measurements, and individualized MRI-based computer simulations for the determination of brain stimulation thresholds. The combined approach with established biological axon models enabled the extrapolation of the measured thresholds for sinusoidally varying electric fields. The findings reveal that the exposure limits are significantly conservative for the brain, especially at frequencies in the range of 300 Hz–5 kHz.

Possible Role of Dorsolateral Prefrontal Cortex in Error Awareness: Single-Pulse TMS Evidence.

Background: Error awareness is essential to maintain an adaptive and goal-directed behavior and is supposed to rely on the activity of the right dorsolateral prefrontal cortex (DLPFC). However, studies employing electrophysiological methods and functional resonance imaging (fMRI) do not allow to establish a causal relationship between error awareness and implicated brain structures.Objective: The study examined the causal relationship between DLPFC activity and error awareness in order to confirm the involvement of the right DLPFC in error awareness and to obtain temporal information about this process, namely when the activity of the right DLPFC is involved in error awareness.Methods: Three experiments with three different samples were conducted employing on-line Transcranial Magnetic Stimulation (TMS). A paired-pulse and a single-pulse on-line TMS paradigm were employed respectively in Experiments 1 and 3, whereas in Experiment 2 a control test was conducted without TMS. In TMS experiments, the right DLPFC was stimulated, considering the left DLPFC and the Vertex as control sites.Results: Experiment 1 showed no effect of paired-pulse TMS over either right or left DLPFC on error awareness. In Experiment 3, independently from the time point during which TMS was delivered, results showed a significant effect of single-pulse TMS over the DLPFC on Stroop Awareness, without evidence for lateralization of the process.Conclusions: Results of the present study partially demonstrate the involvement of the DLPFC in error awareness.

The minimal number of TMS trials required for the reliable assessment of corticospinal excitability, short interval intracortical inhibition, and intracortical facilitation

Transcranial magnetic stimulation (TMS)-induced motor evoked potentials (MEPs) are frequently used to assess corticospinal and intercortical activities. Trial to trial variance of the potentials is commonly observed, and averages of multiple MEPs are usually reported. Multiple trials have resources implications and are not compatible with some experimental protocols. This study investigated the minimum number of MEPs required to reliably assess corticospinal excitability (CSE), short interval intracortical inhibition (SICI) and intercortical facilitation (ICF), within and between sessions. Fifteen healthy volunteers received 35 single-pulse TMS for CSE assessments and 35 paired-pulse TMS for SICI and ICF measurements. Intra- and intersession reliability were examined using intra-class correlation coefficient tests, and stability of the measures was assessed using a general equation estimation analysis. Coefficients of variation were used to probe the effects of inter-individual variability on reliability results. All analyses were carried out on cumulative averages. The optimal number of trials to ensure “excellent” intra and inter-session reliability with low inter-individual variability and the highest level of stability was found to be 20 for CSE and 26 for SICI assessments. Although 30 consecutive trials produced highly reliable ICF measures within a session, inter-session reliability was not significant across 35 trials. These findings have significant implications for improving time efficiency of TMS experiments without compromising intra- or intersession reliability.

TMS SMART – Scalp mapping of annoyance ratings and twitches caused by Transcranial Magnetic Stimulation

BackgroundThe magnetic pulse generated during transcranial magnetic stimulation (TMS) also stimulates cutaneous nerves and muscle fibres, with the most commonly reported side effect being muscle twitches and sometimes painful sensations. These sensations affect behaviour during experimental tasks, presenting a potential confound for ‘online’ TMS studies. New methodOur objective was to systematically map the degree of disturbance (ratings of annoyance, pain, and muscle twitches) caused by TMS at 43 locations across the scalp. Ten participants provided ratings whilst completing a choice reaction time task, and ten different participants provided ratings whilst completing a ‘flanker' reaction time task. ResultsTMS over frontal and inferior regions resulted in the highest ratings of annoyance, pain, and muscle twitches caused by TMS. We predicted the difference in reaction times (RT) under TMS by scalp location and subjective ratings. Frontal and inferior scalp locations showed the greatest cost to RTs under TMS (i.e., slowing), with midline sites showing no or minimal slowing. Increases in subjective ratings of disturbance predicted longer RTs under TMS. Critically, ratings were a better predictor of the cost of TMS than scalp location or scalp-to-cortex distance. The more difficult ‘flanker’ task showed a greater effect of subjective disturbance. Comparison with existing methodsWe provide the data as an online resource (www.tms-smart.info) so that researchers can select control sites that account for the level of general interference in task performance caused by online single-pulse TMS. ConclusionsThe peripheral sensations and discomfort caused by TMS pulses significantly and systematically influence RTs during single-pulse, online TMS experiments.

Retinal and visual cortex distance from transcranial magnetic stimulation of the vertex affects phosphene perception

Recent studies claim that the perception of flashes of light (i.e., phosphenes) can be induced by stimulation of higher visual areas, including parietal cortex, suggesting a critical role of these regions in generating visual percepts. In this study, we show that transcranial magnetic stimulation (TMS) of even the vertex can induce phosphenes, but that their neural origins are likely to be a consequence of current spread into visual areas (e.g., retina or visual cortex). After vertex stimulation, subjects with smaller head circumferences-for whom the distances from the coil to retina and visual cortex are smaller-report a two-fold increase in perceiving phosphenes. In contrast, both smaller and larger headed individuals perceived phosphenes equivalently and on nearly all trials following TMS of early visual cortex. These results demonstrate a critical role of early visual areas but not higher ones in generating visual perceptions. These findings further suggest that phosphenes perceived from TMS of the vertex or parietal cortex arise from induced activity in the retina or nearby early visual cortex and warn against the use of the vertex as a control site for TMS experiments of visual perception.

Reliability of TMS phosphene threshold estimation: Toward a standardized protocol

BackgroundPhosphenes induced by transcranial magnetic stimulation (TMS) are a subjectively described visual phenomenon employed in basic and clinical research as index of the excitability of retinotopically organized areas in the brain. ObjectivePhosphene threshold estimation is a preliminary step in many TMS experiments in visual cognition for setting the appropriate level of TMS doses; however, the lack of a direct comparison of the available methods for phosphene threshold estimation leaves unsolved the reliability of those methods in setting TMS doses. The present work aims at fulfilling this gap. MethodsWe compared the most common methods for phosphene threshold calculation, namely the Method of Constant Stimuli (MOCS), the Modified Binary Search (MOBS) and the Rapid Estimation of Phosphene Threshold (REPT). In two experiments we tested the reliability of PT estimation under each of the three methods, considering the day of administration, participants' expertise in phosphene perception and the sensitivity of each method to the initial values used for the threshold calculation. ResultsWe found that MOCS and REPT have comparable reliability when estimating phosphene thresholds, while MOBS estimations appear less stable. ConclusionsBased on our results, researchers and clinicians can estimate phosphene threshold according to MOCS or REPT equally reliably, depending on their specific investigation goals. We suggest several important factors for consideration when calculating phosphene thresholds and describe strategies to adopt in experimental procedures.

The right angular gyrus controls spontaneous eyeblink rate: A combined structural MRI and TMS study

Spontaneous eyeblink rates vary greatly between people, from several to a few dozen blinks per minute. Nevertheless, it remains unknown which brain region controls generation of spontaneous eyeblinks. To investigate this issue, the present study examined brain anatomy, which reflects inter-individual variability in eyeblink rate using structural magnetic resonance images with voxel-based morphometry (VBM) in 57 participants. The gray matter volume of the right angular gyrus (rAG) was positively associated with an increased eyeblink rate. Next, we examined whether eyeblink rate decreased when activity in the rAG was disrupted by transcranial magnetic stimulation (TMS) with a protocol of continuous theta burst stimulation: TMS of the rAG decreased eyeblink rate by 16%. In contrast, sham stimulation did not significantly affect eyeblink rate. The results from the structural MRI and TMS experiments suggest that the rAG is involved in controlling the generation of spontaneous eyeblinks in humans.

The potential application of transcranial magnetic stimulation in ophthalmology: a brief perspective

Transcranial magnetic stimulation (TMS), while employed in both cognitive investigations and evaluated as a potential therapeutic technique for several conditions, is not widely used in ophthalmology. As a technique, one of the advantages of TMS is that it can create a “virtual lesion”, or temporary disruption of the functioning of a brain area, to facilitate investigation of the processes that the disrupted area may be involved in. In ophthalmology, higher association cortex is associated with visual cognition and control of eye movements, processes which could further be investigated using TMS experiments. This paper aims to provide a perspective of how TMS could be more broadly applied in ophthalmology.