{"doi":"10.1016/j.brs.2021.12.001","title":"Transcranial magnetic stimulation to assess motor neurophysiology after acute stroke in the United States: Feasibility, lessons learned, and values for future research","abstract":"Transcranial magnetic stimulation (TMS) has been widely applied in both basic and clinical neuroscience since its introduction in 1985. In addition to its potential therapeutic value for exciting or inhibiting neural circuits [[1]Rossini P.M. Burke D. Chen R. Cohen L.G. Daskalakis Z. Di Iorio R. et al.Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee.Clin Neurophysiol. 2015; 126: 1071-1107https://doi.org/10.1016/j.clinph.2015.02.001Crossref PubMed Scopus (1249) Google Scholar], TMS can be used to investigate corticomotor excitability (CME), which is a key aspect of voluntary movement [[2]Cortes M. Black-Schaffer R.M. Edwards D.J. Transcranial magnetic stimulation as an investigative tool for motor dysfunction and recovery in stroke: an overview for neurorehabilitation clinicians.Neuromodulation. 2012; 15: 319-325https://doi.org/10.1111/j.1525-1403.2012.00459.xAbstract Full Text Full Text PDF Scopus (0) Google Scholar]. For example, single-pulse TMS can elicit electrical signals, which propagate along descending motor pathways and are recorded as motor evoked potentials (MEP) in target muscles. After stroke, TMS-evoked MEPs have been used to assess the integrity of the descending corticospinal tract (CST) and prognosticate upper limb function [[3]Rosso C. Lamy J.C. Prediction of motor recovery after stroke: being pragmatic or innovative?.Curr Opin Neurol. 2020; 33: 482-487https://doi.org/10.1097/WCO.0000000000000843Crossref PubMed Scopus (8) Google Scholar,[4]Kim B. Winstein C. Can neurological biomarkers of brain impairment Be used to predict poststroke motor recovery? A systematic review.Neurorehabilitation Neural Repair. 2017; 31: 3-24https://doi.org/10.1177/1545968316662708Crossref PubMed Scopus (84) Google Scholar]. Assessment of MEP presence (MEP+) or absence (MEP-) in the affected hand muscle (i.e., first dorsal interosseus (FDI)) at 5–7 days post-stroke is proposed to estimate long-term upper limb function with an MEP+ response predictive of better motor outcomes [[5]Stinear C.M. Byblow W.D. Ackerley S.J. Smith M.C. Borges V.M. Barber P.A. PREP2: a biomarker-based algorithm for predicting upper limb function after stroke.Ann Clin Transl Neurol. 2017; 4: 811-820https://doi.org/10.1002/acn3.488Crossref PubMed Scopus (104) Google Scholar,[6]Smith M.C. Ackerley S.J. Barber P.A. Byblow W.D. Stinear C.M. PREP2 algorithm predictions are correct at 2 Years poststroke for most patients.Neurorehabilitation Neural Repair. 2019; 33: 635-642https://doi.org/10.1177/1545968319860481Crossref PubMed Scopus (16) Google Scholar]. However, assessment of acute stroke MEP status has yet to be implemented in the United States (US). Performing TMS testing during a poststroke acute hospital stay is challenging, particularly in the US healthcare system where hospital stays are 3.9–6.7 days on average [[7]Jackson G. Chari K. National hospital care survey demonstration projects: stroke inpatient hospitalizations.Natl Health Stat Report. 2019; 1–11Google Scholar] and literature provides little guidance on implementation. Further, the dichotomous categorization of MEP+/MEP- may estimate the CST integrity in an over-simplified way [[4]Kim B. Winstein C. Can neurological biomarkers of brain impairment Be used to predict poststroke motor recovery? A systematic review.Neurorehabilitation Neural Repair. 2017; 31: 3-24https://doi.org/10.1177/1545968316662708Crossref PubMed Scopus (84) Google Scholar,[8]Lundquist C.B. Nielsen J.F. Arguissain F.G. Brunner I.C. Accuracy of the upper limb prediction algorithm PREP2 applied 2 Weeks poststroke: a prospective longitudinal study.Neurorehabilitation Neural Repair. 2021; 35: 68-78https://doi.org/10.1177/1545968320971763Crossref PubMed Scopus (7) Google Scholar]. It is possible that other neurophysiologic measures assessed by TMS may be com","journal":"Brain stimulation","year":2021,"id":199597,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":9,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.965,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":715057,"name":"David J. 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Kimberley","orcid":"0000-0001-6397-4054","position":5,"is_corresponding":false},{"id":776144,"name":"Yi‐Ling Kuo","orcid":"0000-0001-5802-4919","position":0,"is_corresponding":true}],"reference_count":11,"raw_metadata":null,"created_at":"2026-07-18T23:50:40.558460Z","pmid":"34890840","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}