Transcranial magnetic stimulation in dystonia (Chapter 43)

Transcranial magnetic stimulation (TMS) is a method of noninvasive brain stimulation that directly affects the cerebral cortex but not deep structures. TMS has been used extensively in patients with primary dystonia to test the excitability of connections within and among motor areas of the cortex, and has provided useful information on pathophysiology; however, interindividual variability in the responses has resulted in difficulties in translating this method into a clinically applicable diagnostic use. In addition, TMS studies have disclosed that dystonia is a disorder linked to a disruption of synaptic "scaling," with an excess of synaptic plasticity that is in keeping with findings obtained in animal models of dystonia. This alteration is a unique feature of organic dystonia and may be helpful in differentiating patients with psychogenic dystonia. Finally, TMS can potentially be used as a therapeutic tool to treat some forms of dystonia, such as focal hand dystonia, where pharmacological options or injections of botulinum toxin are often ineffective.