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 & 11 others Ulrich Palm, Walter Paulus, Emmanuel Poulet, Angelo Quartarone, Fady Rachid, Irena Rektorová, Simone Rossi, Hanna Sahlsten, Martin Schecklmann, David Szekely, Ulf Ziemann

Research output: Contribution to journalReview article

1 Citation (Scopus)

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.

Original languageEnglish
Pages (from-to)474-528
Number of pages55
JournalClinical Neurophysiology
Volume131
Issue number2
DOIs
Publication statusPublished - 1 Feb 2020

Fingerprint

Transcranial Magnetic Stimulation
Therapeutic Uses
Guidelines
Prefrontal Cortex
Depression
Stroke
Motor Cortex
Fibromyalgia
Aphasia
Neuralgia
Post-Traumatic Stress Disorders

Keywords

  • Cortex
  • Indication
  • Neurology
  • Neuromodulation
  • Noninvasive brain stimulation
  • Psychiatry
  • Treatment

Cite this

Lefaucheur, J. P., Aleman, A., Baeken, C., Benninger, D. H., Brunelin, J., Di Lazzaro, V., ... Ziemann, U. (2020). Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018). Clinical Neurophysiology, 131(2), 474-528. https://doi.org/10.1016/j.clinph.2019.11.002
Lefaucheur, Jean Pascal ; Aleman, André ; Baeken, Chris ; Benninger, David H. ; Brunelin, Jérôme ; Di Lazzaro, Vincenzo ; Filipović, Saša R. ; Grefkes, Christian ; Hasan, Alkomiet ; Hummel, Friedhelm C. ; Jääskeläinen, Satu K. ; Langguth, Berthold ; Leocani, Letizia ; Londero, Alain ; Nardone, Raffaele ; Nguyen, Jean Paul ; Nyffeler, Thomas ; Oliveira-Maia, Albino J. ; Oliviero, Antonio ; Padberg, Frank ; Palm, Ulrich ; Paulus, Walter ; Poulet, Emmanuel ; Quartarone, Angelo ; Rachid, Fady ; Rektorová, Irena ; Rossi, Simone ; Sahlsten, Hanna ; Schecklmann, Martin ; Szekely, David ; Ziemann, Ulf. / Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) : An update (2014–2018). In: Clinical Neurophysiology. 2020 ; Vol. 131, No. 2. pp. 474-528.
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Lefaucheur, JP, Aleman, A, Baeken, C, Benninger, DH, Brunelin, J, Di Lazzaro, V, Filipović, SR, Grefkes, C, Hasan, A, Hummel, FC, Jääskeläinen, SK, Langguth, B, Leocani, L, Londero, A, Nardone, R, Nguyen, JP, Nyffeler, T, Oliveira-Maia, AJ, Oliviero, A, Padberg, F, Palm, U, Paulus, W, Poulet, E, Quartarone, A, Rachid, F, Rektorová, I, Rossi, S, Sahlsten, H, Schecklmann, M, Szekely, D & Ziemann, U 2020, 'Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018)', Clinical Neurophysiology, vol. 131, no. 2, pp. 474-528. https://doi.org/10.1016/j.clinph.2019.11.002

Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) : An update (2014–2018). / Lefaucheur, Jean Pascal; Aleman, André; Baeken, Chris; Benninger, David H.; Brunelin, Jérôme; Di Lazzaro, Vincenzo; Filipović, Saša R.; Grefkes, Christian; Hasan, Alkomiet; Hummel, Friedhelm C.; Jääskeläinen, Satu K.; Langguth, Berthold; Leocani, Letizia; Londero, Alain; Nardone, Raffaele; Nguyen, Jean Paul; Nyffeler, Thomas; Oliveira-Maia, Albino J.; Oliviero, Antonio; Padberg, Frank; Palm, Ulrich; Paulus, Walter; Poulet, Emmanuel; Quartarone, Angelo; Rachid, Fady; Rektorová, Irena; Rossi, Simone; Sahlsten, Hanna; Schecklmann, Martin; Szekely, David; Ziemann, Ulf.

In: Clinical Neurophysiology, Vol. 131, No. 2, 01.02.2020, p. 474-528.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS)

T2 - An update (2014–2018)

AU - Lefaucheur, Jean Pascal

AU - Aleman, André

AU - Baeken, Chris

AU - Benninger, David H.

AU - Brunelin, Jérôme

AU - Di Lazzaro, Vincenzo

AU - Filipović, Saša R.

AU - Grefkes, Christian

AU - Hasan, Alkomiet

AU - Hummel, Friedhelm C.

AU - Jääskeläinen, Satu K.

AU - Langguth, Berthold

AU - Leocani, Letizia

AU - Londero, Alain

AU - Nardone, Raffaele

AU - Nguyen, Jean Paul

AU - Nyffeler, Thomas

AU - Oliveira-Maia, Albino J.

AU - Oliviero, Antonio

AU - Padberg, Frank

AU - Palm, Ulrich

AU - Paulus, Walter

AU - Poulet, Emmanuel

AU - Quartarone, Angelo

AU - Rachid, Fady

AU - Rektorová, Irena

AU - Rossi, Simone

AU - Sahlsten, Hanna

AU - Schecklmann, Martin

AU - Szekely, David

AU - Ziemann, Ulf

PY - 2020/2/1

Y1 - 2020/2/1

N2 - 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.

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