Transcranial magnetic stimulation combined with high-density EEG in altered states of consciousness

Martino Napolitani, Olivier Bodart, Paola Canali, Francesca Seregni, Adenauer Casali, Steven Laureys, Mario Rosanova, Marcello Massimini, Olivia Gosseries

Research output: Contribution to journalArticlepeer-review


Background: This review discusses the advantages of transcranial magnetic stimulation combined with high-density electroencephalography (TMS-hdEEG) over other current techniques of brain imaging. Methods and results: Its application was reviewed, focusing particularly on disorders of consciousness, in the perspective of recent theories of consciousness. Assessment of non-communicative patients with disorders of consciousness remains a clinical challenge and objective measures of the level of consciousness are still needed. Current theories suggest that a key requirement for consciousness is the brain's capacity to rapidly integrate information across different specialized cortical areas. TMS-EEG allows the stimulation of any given cortical area and the recording of the immediate electrical cortical response. This technique has recently been successfully employed to measure changes in brain complexity under physiological, pharmacological and pathological conditions. Conclusions: This suggests that TMS-EEG is a reliable tool to discriminate between conscious and unconscious patients at the single subject level. Future works are needed to validate and implement this technique as a clinical tool.

Original languageEnglish
Pages (from-to)1180-1189
Number of pages10
JournalBrain Injury
Issue number9
Publication statusPublished - 2014


  • Consciousness
  • Effective connectivity
  • Electroencephalography
  • Minimally conscious state
  • Transcranial magnetic stimulation
  • Unresponsive wakefulness syndrome
  • Vegetative state

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)
  • Developmental and Educational Psychology


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