Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018)

Jean-Pascal Lefaucheur; André Aleman; Chris Baeken; David H Benninger; Jérôme Brunelin; Vincenzo Di Lazzaro; Saša R Filipović; Christian Grefkes; Alkomiet Hasan; Friedhelm C Hummel; Satu K Jääskeläinen; Berthold Langguth; Letizia Leocani; Alain Londero; Raffaele Nardone; Jean-Paul Nguyen; Thomas Nyffeler; Albino J Oliveira-Maia; Antonio Oliviero; Frank Padberg; Ulrich Palm; Walter Paulus; Emmanuel Poulet; Angelo Quartarone; Fady Rachid; Irena Rektorová; Simone Rossi; Hanna Sahlsten; Martin Schecklmann; David Szekely; Ulf Ziemann

doi:10.1016/j.clinph.2019.11.002

Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018)

Clin Neurophysiol. 2020 Feb;131(2):474-528. doi: 10.1016/j.clinph.2019.11.002. Epub 2020 Jan 1.

Authors

Jean-Pascal Lefaucheur¹, André Aleman², Chris Baeken³, David H Benninger⁴, Jérôme Brunelin⁵, Vincenzo Di Lazzaro⁶, Saša R Filipović⁷, Christian Grefkes⁸, Alkomiet Hasan⁹, Friedhelm C Hummel¹⁰, Satu K Jääskeläinen¹¹, Berthold Langguth¹², Letizia Leocani¹³, Alain Londero¹⁴, Raffaele Nardone¹⁵, Jean-Paul Nguyen¹⁶, Thomas Nyffeler¹⁷, Albino J Oliveira-Maia¹⁸, Antonio Oliviero¹⁹, Frank Padberg⁹, Ulrich Palm²⁰, Walter Paulus²¹, Emmanuel Poulet²², Angelo Quartarone²³, Fady Rachid²⁴, Irena Rektorová²⁵, Simone Rossi²⁶, Hanna Sahlsten²⁷, Martin Schecklmann¹², David Szekely²⁸, Ulf Ziemann²⁹

Affiliations

¹ ENT Team, EA4391, Faculty of Medicine, Paris Est Créteil University, Créteil, France; Clinical Neurophysiology Unit, Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France. Electronic address: [email protected].
² Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
³ Department of Psychiatry and Medical Psychology, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
⁴ Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
⁵ PsyR2 Team, U1028, INSERM and UMR5292, CNRS, Center for Neuroscience Research of Lyon (CRNL), Centre Hospitalier Le Vinatier, Lyon-1 University, Bron, France.
⁶ Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
⁷ Department of Human Neuroscience, Institute for Medical Research, University of Belgrade, Belgrade, Serbia.
⁸ Department of Neurology, Cologne University Hospital, Cologne, Germany; Institute of Neurosciences and Medicine (INM3), Jülich Research Centre, Jülich, Germany.
⁹ Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
¹⁰ Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Defitech Chair in Clinical Neuroengineering, Swiss Federal Institute of Technology (EPFL) Valais and Clinique Romande de Réadaptation, Sion, Switzerland; Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland.
¹¹ Department of Clinical Neurophysiology, Turku University Hospital and University of Turku, Turku, Finland.
¹² Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
¹³ Department of Neurorehabilitation and Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele, University Vita-Salute San Raffaele, Milan, Italy.
¹⁴ Department of Otorhinolaryngology - Head and Neck Surgery, Université Paris Descartes Sorbonne Paris Cité, Hôpital Européen Georges Pompidou, Paris, France.
¹⁵ Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria.
¹⁶ Multidisciplinary Pain Center, Clinique Bretéché, ELSAN, Nantes, France; Multidisciplinary Pain, Palliative and Supportive Care Center, UIC22-CAT2-EA3826, University Hospital, CHU Nord-Laënnec, Nantes, France.
¹⁷ Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland; Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Bern, Switzerland; Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland.
¹⁸ Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal; Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
¹⁹ FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain.
²⁰ Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Medical Park Chiemseeblick, Bernau, Germany.
²¹ Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany.
²² PsyR2 Team, U1028, INSERM and UMR5292, CNRS, Center for Neuroscience Research of Lyon (CRNL), Centre Hospitalier Le Vinatier, Lyon-1 University, Bron, France; Department of Emergency Psychiatry, Edouard Herriot Hospital, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France.
²³ Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy.
²⁴ Private Practice, Geneva, Switzerland.
²⁵ Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic; First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
²⁶ Department of Medicine, Surgery and Neuroscience, Si-BIN Lab Human Physiology Section, Neurology and Clinical Neurophysiology Unit, University of Siena, Siena, Italy.
²⁷ ENT Clinic, Mehiläinen and University of Turku, Turku, Finland.
²⁸ Department of Psychiatry, Princess Grace Hospital, Monaco.
²⁹ Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany.

PMID: 31901449
DOI: 10.1016/j.clinph.2019.11.002

Abstract

A group of European experts reappraised the guidelines on the therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS) previously published in 2014 [Lefaucheur et al., Clin Neurophysiol 2014;125:2150-206]. These updated recommendations take into account all rTMS publications, including data prior to 2014, as well as currently reviewed literature until the end of 2018. Level A evidence (definite efficacy) was reached for: high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the painful side for neuropathic pain; HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC) using a figure-of-8 or a H1-coil for depression; low-frequency (LF) rTMS of contralesional M1 for hand motor recovery in the post-acute stage of stroke. Level B evidence (probable efficacy) was reached for: HF-rTMS of the left M1 or DLPFC for improving quality of life or pain, respectively, in fibromyalgia; HF-rTMS of bilateral M1 regions or the left DLPFC for improving motor impairment or depression, respectively, in Parkinson's disease; HF-rTMS of ipsilesional M1 for promoting motor recovery at the post-acute stage of stroke; intermittent theta burst stimulation targeted to the leg motor cortex for lower limb spasticity in multiple sclerosis; HF-rTMS of the right DLPFC in posttraumatic stress disorder; LF-rTMS of the right inferior frontal gyrus in chronic post-stroke non-fluent aphasia; LF-rTMS of the right DLPFC in depression; and bihemispheric stimulation of the DLPFC combining right-sided LF-rTMS (or continuous theta burst stimulation) and left-sided HF-rTMS (or intermittent theta burst stimulation) in depression. Level A/B evidence is not reached concerning efficacy of rTMS in any other condition. The current recommendations are based on the differences reached in therapeutic efficacy of real vs. sham rTMS protocols, replicated in a sufficient number of independent studies. This does not mean that the benefit produced by rTMS inevitably reaches a level of clinical relevance.

Keywords: Cortex; Indication; Neurology; Neuromodulation; Noninvasive brain stimulation; Psychiatry; Treatment.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Evidence-Based Medicine / standards
Humans
Mental Disorders / therapy*
Nervous System Diseases / therapy*
Practice Guidelines as Topic*
Transcranial Magnetic Stimulation / adverse effects
Transcranial Magnetic Stimulation / methods*
Transcranial Magnetic Stimulation / standards