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

doi:10.1016/j.clinph.2025.2111487

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

^*Corresponding author for this work

Neurology

University of Tübingen
Nanchang University
Rehabilitation Medicine Clinical Research Center of Jiangxi Province
Stanford University
University of Copenhagen
University of Trento
University of Rome La Sapienza
IRCCS Istituto Neurologico Mediterraneo Neuromed - Pozzilli (IS)
University of Cologne
Johannes Gutenberg University Mainz
Leibniz-Institut für Resilienzforschung (LIR)
IMT Institute for Advanced Studies Lucca
University of Milan
IRCCS Fondazione Don Carlo Gnocchi - Milano
University of Rome Tor Vergata
IRCCS Fondazione Santa Lucia - Roma
The Royal's Institute of Mental Health Research
University of Ottawa
Aalborg University
University of California at San Diego
Simon Fraser University
University of Toronto
University of Pittsburgh
Australian National University
Monarch Research Institute
Goethe University Frankfurt
Université Grenoble Alpes
Kansas State University
Deakin University
The Bionics Institute
Swiss Federal Institute of Technology Lausanne
Clinique Romande de Réadaptation
University of Geneva
University of Eastern Finland
New Jersey Institute of Technology
Department of Veterans Affairs
AHEPA University Hospital
University of Ferrara
Aalto University
University of Helsinki
Tel Aviv Sourasky Medical Center
Keio University
Shinjuku-Yoyogi Mental Lab Clinic
International University of Health and Welfare
Beth Israel Deaconess Medical Center
Harvard University
University of Cagliari
Monash University
Adelaide University
South Australian Health And Medical Research Institute
Parkwood Institute
Western University
Leiden University
University of Regensburg
Universität der Bundeswehr München
Université du Québec en Outaouais
Carleton University
University of Nottingham
Hospital of Vipiteno (SABES-ASDAA)
University Health Network
The University of Sydney
Ben-Gurion University of the Negev

Research output: Contribution to journal › Review article › peer-review

16 Scopus citations

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.

Original language	English
Article number	2111487
Journal	Clinical Neurophysiology
Volume	184
DOIs	https://doi.org/10.1016/j.clinph.2025.2111487
State	Published - Apr 2026

Funding

Funders	Funder number
Doris Duke Charitable Foundation
REMED Co., Ltd.
Japan Society for the Promotion of Science
Teijin Pharma
Lundbeck Foundation
Ontario Research Foundation
National Institute of Mental Health
University of Toronto
WuTsai Neuroscience Institute
Stanford Maternal and Child Health Research Institute
Watanabe Foundation
O'Farrel-Principe family
REMED Co. Ltd.
European Commission
Inter Reha
Japan Agency for Medical Research and Development
Centre for Addiction and Mental Health
Temerty Family Foundation
Ministero dell’Istruzione, dell’Università e della Ricerca
HORIZON Doctoral Network
National Center for Advancing Translational Sciences
European Research Council
Novo Nordisk Fonden
Ontario Brain Institute
Ministry of Education, Culture, Sports, Science and Technology
Agence Nationale de la Recherche	ANR-25-CE37-2363
Australian Research Council	FT210100694
O’Farrel-Principe family	CRC 1451
National Recovery and Resilience Plan	IR00011
Innovationsfonden	9068-00025B
Israel Science Foundation	2278/22
Kuopion Yliopistollinen Sairaala	5041742, 5041830
Michael Smith Health Research BC	17727
Marga und Walter Boll-Stiftung	1188607, 468645090
Santé	309921
Epilepsiefonds	2022-10
EU Joint Programme – Neurodegenerative Disease Research	10510062210003
National Institute of Neurological Disorders and Stroke	K23NS116110
Canada Foundation for Innovation	43911
National Institutes of Health	R01MH132074, R01MH126639, R01MH139650, K12TR004788
Horizon 2020 Framework Programme	810377
Deutsche Forschungsgemeinschaft	ZI 542/13-1, 456732630, RTG 2783, 431549029 – SFB 1451, C05
ADAPT-PD	R336-2020-1035
National Health and Medical Research Council	1193596
Natural Sciences and Engineering Research Council of Canada	RGPIN-2015-05783
ZonMw	114025101
EU	101087925
Brain and Behavior Research Foundation	31954
Canadian Institutes of Health Research	165863
Burroughs Wellcome Fund	ERC-2022-SYG - 101071900
National Institute on Aging	P01AG031720
Universitätsklinikum Jena	101059369, 24K10740, ME 5820/4-1, 21H02813, 20222ZLPFC
National Natural Science Foundation of China	82472605, 82560454

Keywords

Cortical excitability
Effective connectivity
Electroencephalography
TMS-EEG
Transcranial magnetic stimulation

Access to Document

10.1016/j.clinph.2025.2111487

Cite this

Ziemann, U., Bai, Y., Baumer, F. M., Beck, M. M., Belardinelli, P., Belvisi, D., Bender, S., Bergmann, T. O., Bortoletto, M., Casarotto, S., Casula, E., Chaves, A. R., de Andrade, D. C., Conte, A., Daskalakis, Z. J., Farzan, F., Ferrarelli, F., Fitzgerald, P. B., Gordon, P. C., ... Ilmoniemi, R. J. (2026). Clinical utility and prospective of TMS–EEG: Updated review from an international expert group. Clinical Neurophysiology, 184, Article 2111487. https://doi.org/10.1016/j.clinph.2025.2111487

@article{92192c0814b2420887a7e7306aeac85c,

title = "Clinical utility and prospective of TMS{\textendash}EEG: Updated review from an international expert group",

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{\textendash}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{\textendash}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{\textendash}844]. Since then, substantial advances have been made in understanding contamination of TMS{\textendash}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.",

keywords = "Cortical excitability, Effective connectivity, Electroencephalography, TMS-EEG, Transcranial magnetic stimulation",

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

note = "Publisher Copyright: {\textcopyright} 2026 The Authors",

year = "2026",

month = apr,

doi = "10.1016/j.clinph.2025.2111487",

language = "אנגלית",

volume = "184",

journal = "Clinical Neurophysiology",

issn = "1388-2457",

publisher = "Elsevier Ireland Ltd",

}

Ziemann, U, Bai, Y, Baumer, FM, Beck, MM, Belardinelli, P, Belvisi, D, Bender, S, Bergmann, TO, Bortoletto, M, Casarotto, S, Casula, E, Chaves, AR, de Andrade, DC, Conte, A, Daskalakis, ZJ, Farzan, F, Ferrarelli, F, Fitzgerald, PB, Gordon, PC, Grefkes, C, Harquel, S, Hernandez-Pavon, JC, Hill, AT, Hoy, KE, Hummel, FC, Julkunen, P, Kallioniemi, E, Keller, CJ, Kimiskidis, VK, Kirkovski, M, Koch, G, Leodori, G, Lioumis, P, Määttä, S, Maidan, I, Massimini, M, Mengel, A, Metsomaa, J, Miniussi, C, Mutanen, TP, Noda, Y, Ozdemir, RA, Raffin, E, Rocchi, L, Rogasch, NC, Rosanova, M, Santarnecchi, E, Sarasso, S, Schabrun, SM, Shafi, MM, Siebner, HR, Tolner, EA, Tomasevic, L, Tremblay, S, Tscherpel, C, Veniero, D, Versace, V, Voineskos, D, Vucic, S, Zangen, A, Zrenner, C & Ilmoniemi, RJ 2026, 'Clinical utility and prospective of TMS–EEG: Updated review from an international expert group', Clinical Neurophysiology, vol. 184, 2111487. https://doi.org/10.1016/j.clinph.2025.2111487

TY - JOUR

T1 - Clinical utility and prospective of TMS–EEG

T2 - Updated review from an international expert group

AU - Ziemann, Ulf

AU - Bai, Yang

AU - Baumer, Fiona M.

AU - Beck, Mikkel M.

AU - Belardinelli, Paolo

AU - Belvisi, Daniele

AU - Bender, Stephan

AU - Bergmann, Til Ole

AU - Bortoletto, Marta

AU - Casarotto, Silvia

AU - Casula, Elias

AU - Chaves, Arthur R.

AU - de Andrade, Daniel Ciampi

AU - Conte, Antonella

AU - Daskalakis, Zafiris J.

AU - Farzan, Faranak

AU - Ferrarelli, Fabio

AU - Fitzgerald, Paul B.

AU - Gordon, Pedro C.

AU - Grefkes, Christian

AU - Harquel, Sylvain

AU - Hernandez-Pavon, Julio C.

AU - Hill, Aron T.

AU - Hoy, Kate E.

AU - Hummel, Friedhelm C.

AU - Julkunen, Petro

AU - Kallioniemi, Elisa

AU - Keller, Corey J.

AU - Kimiskidis, Vasilios K.

AU - Kirkovski, Melissa

AU - Koch, Giacomo

AU - Leodori, Giorgio

AU - Lioumis, Pantelis

AU - Määttä, Sara

AU - Maidan, Inbal

AU - Massimini, Marcello

AU - Mengel, Annerose

AU - Metsomaa, Johanna

AU - Miniussi, Carlo

AU - Mutanen, Tuomas P.

AU - Noda, Yoshihiro

AU - Ozdemir, Recep A.

AU - Raffin, Estelle

AU - Rocchi, Lorenzo

AU - Rogasch, Nigel C.

AU - Rosanova, Mario

AU - Santarnecchi, Emiliano

AU - Sarasso, Simone

AU - Schabrun, Siobhan M.

AU - Shafi, Mouhsin M.

AU - Siebner, Hartwig R.

AU - Tolner, Else A.

AU - Tomasevic, Leo

AU - Tremblay, Sara

AU - Tscherpel, Caroline

AU - Veniero, Domenica

AU - Versace, Viviana

AU - Voineskos, Daphne

AU - Vucic, Steve

AU - Zangen, Abraham

AU - Zrenner, Christoph

AU - Ilmoniemi, Risto J.

PY - 2026/4

Y1 - 2026/4

N2 - 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.

AB - 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.

KW - Cortical excitability

KW - Effective connectivity

KW - Electroencephalography

KW - TMS-EEG

KW - Transcranial magnetic stimulation

UR - https://www.scopus.com/pages/publications/105030054243

U2 - 10.1016/j.clinph.2025.2111487

DO - 10.1016/j.clinph.2025.2111487

M3 - ???researchoutput.researchoutputtypes.contributiontojournal.systematicreview???

C2 - 41688232

AN - SCOPUS:105030054243

SN - 1388-2457

VL - 184

JO - Clinical Neurophysiology

JF - Clinical Neurophysiology

M1 - 2111487

ER -

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

Abstract

Funding

Keywords

Access to Document

Other files and links

Fingerprint

Cite this