Trial reportBrain stimulation
TMS of primary motor cortex with a biphasic pulse activates two independent sets of excitable neurones.
Trial report in Brain stimulation. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
38 citing papers in PubMed, 2 syntheses or guidelines pooled it, 87 citations in OpenAlex.
- On the reliability of motor evoked potentials in hand muscles of healthy adults: a systematic review.Frontiers in human neuroscience · 2023Pooled it
- Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines.Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2021Guideline
- The effects of D-Cycloserine on corticospinal excitability after repeated spaced intermittent theta-burst transcranial magnetic stimulation: A randomized controlled trial in healthy individuals.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2023Trial
- Cervicothoracic trans-spinal magnetic stimulation: effect of coil position and orientation on spinal motor evoked potentials.Experimental brain research · 2026Article
- Precision in Delivery, Variability in Response: A Multiscale Mechanistic Framework for Neuronavigated Transcranial Magnetic Stimulation.Brain sciences · 2026Review
- Pulse waveform and current direction alter network-level TMS-induced functional connectivity: Evidence from TMS-EEG.NeuroImage · 2026Article
- Versatility of Transcranial Magnetic Stimulation: A Review of Diagnostic and Therapeutic Applications.Brain sciences · 2026Review
- Controllable Pulse Parameter Transcranial Magnetic Stimulation in Fibromyalgia: A Randomized Control Study.Journal of pain research · 2026Article
- The stretch-shortening cycle effect is not associated with cortical or spinal excitability modulations.The Journal of physiology · 2025Article
- Sensitivity to Instruction Strategies in Motor Learning Is Predicted by Anterior-Posterior TMS Motor Thresholds.Brain sciences · 2025Article
- Height-dependent variation in corticospinal excitability modulation after active but not sham intermittent theta burst stimulation.IBRO neuroscience reports · 2025Article
- Stimulation Parameters Recruit Distinct Cortico-Cortical Pathways: Insights from Microstate Analysis on TMS-Evoked Potentials.Brain topography · 2025Article
- Physiological Biomarkers of Upper Motor Neuron Dysfunction in ALS.Brain sciences · 2024Review
- M2M-InvNet: Human Motor Cortex Mapping From Multi-Muscle Response Using TMS and Generative 3D Convolutional Network.IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society · 2024Article
- The Cortical Silent Period and Its Association with Fatigue in Multiple Sclerosis: The Need for Standardized Data Collection.Brain sciences · 2023Article
- Optimized monophasic pulses with equivalent electric field for rapid-rate transcranial magnetic stimulation.Journal of neural engineering · 2023Article
- Dependence of cortical neuronal strength-duration properties on TMS pulse shape.Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2023Article
- Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee.Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2023Review
- Modular pulse synthesizer for transcranial magnetic stimulation with fully adjustable pulse shape and sequence.Journal of neural engineering · 2022Article
- Identifying transcranial magnetic stimulation induced EEG signatures of different neuronal elements in primary motor cortex.Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2022Article
Corrections and comments
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Authors and funding
8 authors at 5 institutions in 3 countries.
Funding
Abstract
backgroundBiphasic pulses produced by most commercially available TMS machines have a cosine waveform, which makes it difficult to study the interaction between the two phases of stimulation.
objectiveWe used a controllable pulse TMS (cTMS) device delivering quasi-rectangular pulse outputs to investigate whether monophasic are more effective than biphasic pulses.
methodsTemporally symmetric ("biphasic") or highly asymmetric ("monophasic") charge-balanced biphasic stimuli were used to target the hand area of motor cortex in the anterior-posterior (AP) or posterior-anterior (PA) initial current direction.
resultsWe observed the lowest motor thresholds and shortest motor evoked potential (MEP) latencies with initial PA pulses, and highest thresholds and longest latencies with AP pulses. Increasing pulse symmetry tended to increase threshold with a PA direction whereas it lowered thresholds and shortened latencies with an AP direction. Furthermore, it steepened the MEP input-output curve with both directions.
conclusions"Biphasic" TMS pulses can be viewed as two monophasic pulses of opposite directions, each stimulating a different set of interneurons with different thresholds (PA < AP). At threshold, the reverse phase of an initially PA pulse increases threshold compared with "monophasic" stimulation. At higher intensities, the reverse phase begins to activate AP-sensitive neurones and increase the effectiveness of stimulation above that of a "monophasic" PA pulse. "Biphasic" stimulation with initially AP pulses is dominated at threshold by activation produced by the lower threshold reverse (PA) phase. SIGNIFICANCE: The effects of biphasic stimulation are best understood as the summed output of two independent sets of directionally selective neural populations.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.