Clinical utility and prospective of TMS-EEG: Updated review from an international expert group

Ulf Ziemann, Yang Bai, Fiona M Baumer, Mikkel M Beck, Paolo Belardinelli, Daniele Belvisi, Stephan Bender, Til Ole Bergmann, Marta Bortoletto, Silvia Casarotto, Elias Casula, Arthur R Chaves, Daniel Ciampi de Andrade, Antonella Conte, Zafiris J Daskalakis, Faranak Farzan, Fabio Ferrarelli, Paul B Fitzgerald, Pedro C Gordon, Christian Grefkes, Sylvain Harquel, Julio C Hernandez-Pavon, Aron T Hill, Kate E Hoy, Friedhelm C Hummel, Petro Julkunen, Elisa Kallioniemi, Corey J Keller, Vasilios K Kimiskidis, Melissa Kirkovski, Giacomo Koch, Giorgio Leodori, Pantelis Lioumis, Sara Määttä, Inbal Maidan, Marcello Massimini, Annerose Mengel, Johanna Metsomaa, Carlo Miniussi, Tuomas P Mutanen, Yoshihiro Noda, Recep A Ozdemir, Estelle Raffin, Lorenzo Rocchi, Nigel C Rogasch, Mario Rosanova, Emiliano Santarnecchi, Simone Sarasso, Siobhan M Schabrun, Mouhsin M Shafi, Hartwig R Siebner, Else A Tolner, Leo Tomasevic, Sara Tremblay, Caroline Tscherpel, Domenica Veniero, Viviana Versace, Daphne Voineskos, Steve Vucic, Abraham Zangen, Christoph Zrenner, Risto J Ilmoniemi

Clin Neurophysiol. 2026 Jan 9:2111487. doi: 10.1016/j.clinph.2025.2111487. Online ahead of print.

ABSTRACT

Transcranial magnetic stimulation (TMS) is a non-invasive technique to stimulate the brain, while electroencephalography (EEG) is a non-invasive technique to record its electrical activity. Their combined use (TMS-EEG) has been established only relatively recently, after successful development of TMS-compatible EEG amplifiers. TMS-EEG offers the unparalleled opportunity to directly perturb the brain with TMS and simultaneously record its response with EEG. This allows inferences on causal input-output relationships, therefore going critically beyond purely observational techniques, such as resting-state EEG or functional MRI, in the study of brain dynamics. This consensus review updates the work of Tremblay and coworkers [Clin Neurophysiol 2019; 130: 802-844]. Since then, substantial advances have been made in understanding contamination of TMS-EEG signals by physiological and non-physiological artifacts, as well as in developing strategies to avoid or control them. In parallel, new insights have emerged regarding the physiological mechanisms underlying TMS-EEG responses and their diagnostic and prognostic utility in a broad range of psychiatric and neurological disorders. As such, TMS-EEG is rapidly shaping a dynamic new field in clinical neurophysiology and neuroscience. This review provides a critical and comprehensive synthesis of current knowledge, including practical guidance for implementing TMS-EEG in the clinical setting.

PMID:41688232 | DOI:10.1016/j.clinph.2025.2111487