
BJMB
Brazilian Journal of Motor Behavior
!
Fernandez-del-
Olmo et al.
https://doi.org/10.20338/bjmb.v15i2.213
Neuromodulation by non-invasive brain stimulation (NIBS): a step back to move forward
MIGUEL FERNANDEZ-DEL-OLMO
1
| MARTA SEVILLA-SANCHEZ
2
| GONZALO MARQUEZ-SANCHEZ
2
| DAWSON
KIDGELL
3
| MARIE-HELENE MILOT
4
| RUUD W. SELLES
5,6
| JOHN ROTHWELL
7
| TIBOR HORTOBÁGYI
8
1
Area of Sport Sciences, Faculty of Sports Sciences and Physical Education, Center for Sport Studies, King Juan Carlos University, Madrid, Spain.
2
Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruna, A Coruna, Spain.
3
Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia.
4
Centre de recherche sur le vieillissement, École de réadaptation, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada.
5
Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
6
Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
7
Sobell Department of Motor Neuroscience and Movement Disorders, University College London, Institute of Neurology, London, United Kingdom.
8
Center for Human Movement Sciences, University Medical Center Groningen, The University of Groningen, Groningen, The Netherlands.
Correspondence to: Miguel Fernandez del Olmo - Area of Sport Sciences, Faculty of Sports Sciences and Physical Education - Center for Sport Studies - King Juan
Carlos University - Camino del Molino, s/n, 28943 Fuenlabrada, Madrid, Spain.
email: miguel.delolmo@urjc.es
https://doi.org/10.20338/bjmb.v15i2.213
ABBREVIATIONS
iTBS Intermittent theta burst (magnetic) stimulation
M1 primary motor cortex
NIBS non-invasive brain stimulation
rTMS repetitive transcranial magnetic stimulation
tDCS transcranial direct current stimulation
PUBLICATION DATA
Received 25 11 2020
Accepted 30 11 2020
Published 01 06 2021
The first studies on non-invasive brain stimulation (NIBS) appeared barely 20
years ago showing lasting changes in cortical excitability of motor areas following repetitive
transcranial magnetic stimulation (rTMS)
1
and transcranial direct current stimulation
(tDCS).
2
These pioneering studies opened up new vistas for the exploration of treatment
alternatives for diverse pathologies (from depression to joint instability) and for the
enhancement of cognitive and motor function. Indeed, the ~2,000 papers published on
NIBS during the past two years is a resolute expression of the effort to fully develop these
techniques of cortical stimulation for quick, customized, reliable, lasting, and most
importantly, corrective modulation of putative brain circuits underlying neurological,
orthopedic, behavioral, and cognitive impairments.
As a result of this immense research effort, NIBS-induced neuromodulatory
treatments are now considered ‘evidence-based’ and have become readily available at
clinics and rehabilitation centers. With exception of rTMS for treating depressive symptoms,
recommendation for therapeutic use of NIBS is based mainly on meta-analytical estimates
of NIBS effects observed in studies using very small and heterogenous samples, and
without randomization, blinding to treatment, or placebo stimulation. The aim of the current
opinion is not to cast a critical light on the NIBS literature. Rather, we wish to reflect on key
features of the purported neuromodulatory effects of NIBS, i.e., the inconsistency in
inducing changes in brain excitability and replicating such changes induced by NIBS.
Depending on the nature (magnetic, electrical) and the wave properties of the
stimulus, NIBS can increase or decrease the excitability of circuits targeted. Intermittent