title: Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS).
abstract: A group of European experts was commissioned to establish guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) from evidence published up until March 2014, regarding pain, movement disorders, stroke, amyotrophic lateral sclerosis, multiple sclerosis, epilepsy, consciousness disorders, tinnitus, depression, anxiety disorders, obsessive-compulsive disorder, schizophrenia, craving/addiction, and conversion. Despite unavoidable inhomogeneities, there is a sufficient body of evidence to accept with level A (definite efficacy) the analgesic effect of high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the pain and the antidepressant effect of HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC). A Level B recommendation (probable efficacy) is proposed for the antidepressant effect of low-frequency (LF) rTMS of the right DLPFC, HF-rTMS of the left DLPFC for the negative symptoms of schizophrenia, and LF-rTMS of contralesional M1 in chronic motor stroke. The effects of rTMS in a number of indications reach level C (possible efficacy), including LF-rTMS of the left temporoparietal cortex in tinnitus and auditory hallucinations. It remains to determine how to optimize rTMS protocols and techniques to give them relevance in routine clinical practice. In addition, professionals carrying out rTMS protocols should undergo rigorous training to ensure the quality of the technical realization, guarantee the proper care of patients, and maximize the chances of success. Under these conditions, the therapeutic use of rTMS should be able to develop in the coming years.
authors.affiliation: Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France. Electronic address: jean-pascal.lefaucheur@hmn.aphp.fr.
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Lefaucheur
authors.affiliation: Neurophysiology and Epilepsy Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Bron, France; Inserm U 1028, NeuroPain Team, Neuroscience Research Center of Lyon (CRNL), Lyon-1 University, Bron, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: André-Obadia
authors.affiliation: Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Antal
authors.affiliation: Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France.
authors.forename: Samar S
authors.initials: SS
authors.lastname: Ayache
authors.affiliation: Department of Psychiatry and Medical Psychology, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium.
authors.forename: Chris
authors.initials: C
authors.lastname: Baeken
authors.affiliation: Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: David H
authors.initials: DH
authors.lastname: Benninger
authors.affiliation: Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale "A. Avogadro", Novara, Italy.
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Cantello
authors.affiliation: Unit of Neurology, Florence Health Authority, Firenze, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Cincotta
authors.affiliation: Institute of Physiology, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal.
authors.forename: Mamede
authors.initials: M
authors.lastname: de Carvalho
authors.affiliation: Brai(2)n, Tinnitus Research Initiative Clinic Antwerp, Belgium; Department of Neurosurgery, University Hospital Antwerp, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: De Ridder
authors.affiliation: Department of Clinical Neurophysiology, Lille University Hospital, Lille, France; ULCO, Lille-Nord de France University, Lille, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Devanne
authors.affiliation: Department of Neurosciences, Institute of Neurology, Campus Bio-Medico University, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Di Lazzaro
authors.affiliation: Department of Neurophysiology, Institute for Medical Research, University of Belgrade, Beograd, Serbia.
authors.forename: Saša R
authors.initials: SR
authors.lastname: Filipović
authors.affiliation: Brain Imaging and Neurostimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Friedhelm C
authors.initials: FC
authors.lastname: Hummel
authors.affiliation: Department of Clinical Neurophysiology, Turku University Hospital, University of Turku, Turku, Finland.
authors.forename: Satu K
authors.initials: SK
authors.lastname: Jääskeläinen
authors.affiliation: Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Vasilios K
authors.initials: VK
authors.lastname: Kimiskidis
authors.affiliation: Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Koch
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
authors.forename: Berthold
authors.initials: B
authors.lastname: Langguth
authors.affiliation: Perception and Eye Movement Laboratory, Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Nyffeler
authors.affiliation: FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Oliviero
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Padberg
authors.affiliation: Department of Emergency Psychiatry, CHU Lyon, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; EAM 4615, Lyon-1 University, Bron, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Poulet
authors.affiliation: Brain Investigation & Neuromodulation Lab, Unit of Neurology and Clinical Neurophysiology, Department of Neuroscience, University of Siena, Siena, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Rossi
authors.affiliation: Brain Connectivity Laboratory, IRCCS San Raffaele Pisana, Rome, Italy; Institute of Neurology, Catholic University, Rome, Italy.
authors.forename: Paolo Maria
authors.initials: PM
authors.lastname: Rossini
authors.affiliation: Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom.
authors.forename: John C
authors.initials: JC
authors.lastname: Rothwell
authors.affiliation: Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany.
authors.forename: Carlos
authors.initials: C
authors.lastname: Schönfeldt-Lecuona
authors.affiliation: Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
authors.forename: Hartwig R
authors.initials: HR
authors.lastname: Siebner
authors.affiliation: Parnassia Psychiatric Institute, The Hague, The Netherlands.
authors.forename: Christina W
authors.initials: CW
authors.lastname: Slotema
authors.affiliation: Oxford Centre for Functional MRI of the Brain (FMRIB), Department of Clinical Neurosciences, University of Oxford, United Kingdom.
authors.forename: Charlotte J
authors.initials: CJ
authors.lastname: Stagg
authors.affiliation: EMG Unit, Neurology Service, Hospital Clinic, Department of Medicine, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Valls-Sole
authors.affiliation: Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Ziemann
authors.affiliation: Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Paulus
authors.affiliation: Inserm U 1028, NeuroPain Team, Neuroscience Research Center of Lyon (CRNL), Lyon-1 University, Bron, France; Pain Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Bron, France.
authors.forename: Luis
authors.initials: L
authors.lastname: Garcia-Larrea
mesh_terms: D002540:Cerebral Cortex / Q000503:physiopathology*; D004827:Epilepsy / Q000503:physiopathology / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D001523:Mental Disorders / Q000503:physiopathology / Q000628:therapy*; D009069:Movement Disorders / Q000503:physiopathology / Q000628:therapy*; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000628:therapy*; D020521:Stroke / Q000503:physiopathology / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
keywords: Cortex; Indication; Neurological disease; Neuromodulation; Noninvasive brain stimulation; Psychiatric disease; TMS; Treatment