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Chapter 32
TMS–EEG: A Tool to Probe Key Features of Human Thalamocortical Circuits
Silvia Casarotto and Mario Rosanova
Abstract Transcranial magnetic stimulation combined with electroencephalogra-
phy
(TMS–EEG) offers a unique opportunity to investigate human thalamocortical circuits non-invasively from a causal perspective. Delivering a controlled perturba­tion—the TMS pulse—to a targeted cortical region and recording the ensui ng TMS-evoked potentials (TEPs) reveals physiological features that complement those accessible through observation alone, such as through the resting EEG. These features include cortical excitability, effective connectivity, oscillatory dynamics, and recurrent interactions across cortical and thalamocortical circuits. Methodological advances—ranging from TMS-compa tible EEG equipment to bio­logical artefact-control procedures—now allow researchers to isolate genuine neural responses from stimulation-related confounds with increasing reliability. These insights are turning TMS–EEG into a versatile tool for basic and clinical neurosci­ence, enabling the characterization of circuit-level mechanisms across behavioral states, from wakefulness and sleep to anesthesia and disorders of consciousness, as well as fostering the development of biomarkers relevant for stroke, psychiatric disorders, neurodegeneration, and recovery of function. This chapter provides an overview of the instrumentation, experimental procedures, physiological principles, and representative applications of TMS–EEG, highlighting both its strengths and limitations. We argue that TMS–EEG holds substantial promise for advancing mechanistic models of thalamocortical function in humans and for developing clinically meaningful biomarkers.
Keywords TMS–EEG · Thalamocortical
circuits · TMS-evoked potentials (TEPs) ·
Effective connectivity · Neurophysiological biomarkers
S. Casarotto Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy M. Rosanova (*)
Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy e-mail:
mario.rosanova@unimi.it
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2026
Warbrick (ed.), The EEG Handbook,
T.
https://doi.org/10.1007/978-3-032-20450-9_32
479
480 S. Casarotto and M. Rosanova

32.1 Introduction

The thalamocortical system plays a central role in human perception, motor behav­ior, cognition, and consciousness. These functions arise from interactions between local cortical circuits and long-range cortico-cortical and thalamocortical loops that regulate excitability, synchronize oscillations, and sustain recurrent processing. Dysregulation of these mechanisms characterizes many neurological and psychiatric disorders, in which altered excitability, connectivity, or oscillatory dynamics impair information processing and behavior. Understan ding how these processes failand how they may be restoredrequires tools capable of probing thalamocortical function directly and non-invasively. Transcranial magnetic stimulation combined with electroencephalography (TMS-EEG) is uniquely suited to this goal, as it captures how neural activity elicited by a focal perturbation propagates through thalamocortical circuits.
Early TMS-evoked potentials (TEPs) components (10–50 ms) primarily reect
cortical excitability and the recruitment of intracortical and thalamocortical
local circuits, indexing changes in membrane excitability, synaptic efcacy, or neuromodulatory state. At longer latencies (>50 ms), TEPs reveal the propagation of activity across connected regions, providing a direct measure of effective con­nectivity that is highly sensitive to brain state, despite preserved structural connec­tivity—for example, during NREM sleep, anesthesia, or disorders of consciousness. In addition, TMS can elicit sustained oscillatory responses at frequencies character­istic of specic cortical targets, reecting the natural frequencies of corticothalamic modules and conveying information about excitation–inhibition balance and net­work organization. State-dependent modulation of these responses distinguishes conditions with preserved causal interactions, such as wakefulness or the minimally conscious state, from those in which large-scale dynamics collapse, as in deep sleep, anesthesia, or unresponsive wakefulness syndrome. The degree of such complex causal interactions can be quantied by TMS–EEG–derived measures such as the Perturbational Complexity Index (PCI), which discriminates between clinically similar conditions with high sensitivity.
This chapter provides a focused overview of the methodological and physiolog-
foundations of TMS–EEG , with particular emphasis on its application to
ical thalamocortical circuits. We review the instrumentation and experimental proce­dures required for reliable data acquisition, summarize the physiological interpreta­tion of TEPs, oscillatory responses, connectivity and complexity metrics, and present representative applications in basic, clinical, and translational neuroscience .
32.2 TMS–EEG: A Brief Overview
TMS is a non-invasive brain stimulation technique based on Faradays law of electromagnetic induction. A brief, high-intensity current pulsetypically several kiloamperes and lasting a few hundred microsecondsis delivered through a stim­ulation coil (Ilmoniemi et al.,
1999), generating a rapidly time-varying magnetic
32 TMS–EEG: A Tool to Probe Key Features of Human Thalamocortical Circuits 481
eld that penetrates the scalp and skull with minimal attenuation and induces an electric eld in a focal region of the cerebral cortex (Ilmoniemi et al., magne
tic eld strengths usually range between 1 and 3 tesla and rise within ~50–­100 microseconds, providing TMS with submillisecond temporal precision. This temporal accuracy allows controlled perturbation of neuronal membrane potentials and modulation of ongoing and oscillatory brain activity, enabling causal interroga­tion of human brain circuits that are otherwise inaccessible to purely observational methods (Hernandez-Pavon et al.,
Electroencephalography (EEG) records the electrical activity generated by large populations of cortical neurons via scalp electrodes, offering millisecond temporal resolution and spatial resolution that depends on electrode density and head con­ductivity (Ilmoniemi & Sarvas, inferen
ce, it yields a direct measure of brain dynamics as they evolve over time.
Because of the intense electric eld generated by the TMS pulse, combining TMS
EEG required the development of dedicated TMS-compatible ampliers. Early
with attempts in 1989 demonstrated the feasibility of recording transcallosal and cerebellar–cortical responses (Cracco et al., use
of conventional EEG ampliers resulted in large pulse-related artifacts that prevented reliable recording under the coil. Fully TMS-compatible ampliers intro­duced about twenty years ago (Ilmoniemi et al., 1997; Virtanen et al., 1999)
ssed these electromagnetic artifacts and enabled the reliable recording of
suppre artifact-free TMS-evoked potentials (TEPs) within a few milliseconds (Ilmoniemi et al., 1997; Paus et al. 2001; Massimini et al., 2005). More recently, DC ampliers with
wide dynamic range and high sampling rates (
the ability to capture TEPs without long-lasting pulse artifacts (Bonato et al., 2006).
The concurrent application of TMS and EEG enables the recording of neural
respon
ses to a precisely timed external perturbation. This combined approach allows investigators to (i) evoke and measure cortical responses, (ii) probe how ongoing brain activity is perturbed by stimulation, and (iii) implement state-dependent or closed-loop stimulation paradigms in which TMS is adapted to the current brain state (Bergmann,
Together, these features make TMS–EEG a powerful framework for studying the causal and thalamocortical circuits in health and disesase (Ziemann et al., 2026 10.1016/j. clinph.2025.2111487).
2018; Hernandez-Pavon et al., 2023; Zrenner & Ziemann, 2024 ).
organization, state dependence, and dynamical properties of human cortical
2023; Koponen et al., 2018b).
2019). While EEG alone provides limited causal
1989; Amassian et al., 1992), but the
5 kHz) have further improved
1997). Peak

32.2.1 Equipment

The acquisition of high-quality TMS–EEG data depends on the careful selection and integration of dedicated hardware and software components (Fig. typica
l system includes (i) the TMS stimulator and coil, (ii) a TMS-compatible EEG amplier, and (iii) a neuronavigation system for accurate, reproducible targeting. Additional elementssuch as a graphical user interface for real-time monitoring and
32.1, Panel A). A