In recent years, new approaches for the technique of transcranial magnetic stimulation (TMS) have been developed. TMS is presently used as a research and clinical tool in the field of epilepsy, either combined with electromyography (TMS-EMG) and/or electroencephalography (TMS-EEG). Recent studies have shown that these techniques can identify changes of cortical excitability associated with specific epilepsy syndromes. There is recent evidence that TMS may serve as a biomarker with prognostic value, being able to predict a good response to pharmacologic or surgical procedures. In addition, TMS has shown a diagnostic potential capable to localize non-invasively the epileptogenic zone. Furthermore, TMS can be used as a therapeutic tool in drug-resistant epilepsy, refractory status epilepticus and in patients with epilepsia partialis continua over primary motor or sensory cortex. However, more studies are needed to identify and optimize the best possible TMS parameters for each condition.
Future research with TMS can help us to understand some of the pathophysiological mechanisms underlying human epilepsy. TMS has the potential to become a clinical tool with proper diagnostic, prognostic and therapeutic value.