TMS is a powerful new tool with extremely interesting research and therapeutic potentials. Further understanding of the ways by which TMS changes neuronal function, especially as a function of its use parameters, will improve its ability to answer neuroscience questions as well as to treat diseases. Because of its noninvasiveness, it does not readily fit under the umbrella of neurosurgery. Nevertheless, it is important for neurosurgeons to be aware of TMS, because findings from TMS studies will have implications for neurosurgical approaches like DBS and VNS. Indeed, it is possible to think of using TMS as a potential noninvasive initial screening tool to identify whether perturbation of a circuit has short-term clinical effects. In the example of chronic refractory depression or OCD, which is generally a chronic illness, it might then follow that rather than having daily or weekly TMS for the rest of their lives, patients would have DBS electrodes implanted in the same circuit. Whatever road the future takes, TMS is an important new tool that will likely be of interest to neurosurgeons over the next 20 years and perhaps even longer.
Bibliographical noteFunding Information:
Drs George, Nahas, and Kozel's work with transcranial magnetic stimulation (TMS) has been supported in part by research grants from National Alliance for Research on Schizophrenia and Depression (NARSAD), the Stanley Foundation, the Borderline Personality Disorders Research Foundation (BPDRF), NINDS grant RO1-AG40956, and the Defense Advanced Projects Agency (DARPA).