Clinical neurophysiology practice · 2026
Temperature effects on TMS-Derived measures of cortical excitability: a systematic review and implications for a warming climate.
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Peroni Giulio, Ravenscroft Charlotte, Balestrini Simona, Sisodiya Sanjay M
Аннотация
OBJECTIVE: To systematically review evidence on the effects of temperature manipulation on transcranial magnetic stimulation (TMS)-derived measures of cortical excitability in healthy individuals and temperature-sensitive neurological conditions.
METHODS: Following PRISMA guidelines, we searched PubMed, Cochrane Library, EMBASE, and MEDLINE through November-December 2025. Studies reporting quantitative TMS-EMG or TMS-EEG outcomes after experimentally induced, non-noxious temperature changes were included. Parallel searches examined healthy populations and six temperature-sensitive neurological conditions.
RESULTS: Twenty-one studies in healthy individuals (n = 360, mean age 30.9 ± 5.7 years) and one study in multiple sclerosis (MS) met inclusion criteria. Temperature manipulations included whole-body (core changes -2.4 °C to +1.5 °C) and focal interventions (-22 °C to +18 °C). Most studies reported no significant effects on motor evoked potential (MEP) amplitude (73.3%), latency (71.4%), cortical silent period (85.7%), or paired-pulse measures (100%). Effect directions were inconsistent in studies reporting significant findings. The single MS study demonstrated heat-induced impairment, with increased motor threshold and decreased MEP amplitude, not observed in controls.
CONCLUSIONS: Experimental TMS studies largely show null effects of temperature on cortical excitability in healthy individuals, contrasting with epidemiological evidence of temperature-related neurological vulnerability. This discrepancy likely reflects modest brain temperature changes, peripheral confounds, and limited ecological validity of current paradigms.
SIGNIFICANCE: There is a critical need for climate-relevant experimental designs incorporating sustained thermal exposure and direct cortical readouts (e.g., TMS-EEG) in temperature-sensitive populations to elucidate mechanisms of thermal vulnerability.
METHODS: Following PRISMA guidelines, we searched PubMed, Cochrane Library, EMBASE, and MEDLINE through November-December 2025. Studies reporting quantitative TMS-EMG or TMS-EEG outcomes after experimentally induced, non-noxious temperature changes were included. Parallel searches examined healthy populations and six temperature-sensitive neurological conditions.
RESULTS: Twenty-one studies in healthy individuals (n = 360, mean age 30.9 ± 5.7 years) and one study in multiple sclerosis (MS) met inclusion criteria. Temperature manipulations included whole-body (core changes -2.4 °C to +1.5 °C) and focal interventions (-22 °C to +18 °C). Most studies reported no significant effects on motor evoked potential (MEP) amplitude (73.3%), latency (71.4%), cortical silent period (85.7%), or paired-pulse measures (100%). Effect directions were inconsistent in studies reporting significant findings. The single MS study demonstrated heat-induced impairment, with increased motor threshold and decreased MEP amplitude, not observed in controls.
CONCLUSIONS: Experimental TMS studies largely show null effects of temperature on cortical excitability in healthy individuals, contrasting with epidemiological evidence of temperature-related neurological vulnerability. This discrepancy likely reflects modest brain temperature changes, peripheral confounds, and limited ecological validity of current paradigms.
SIGNIFICANCE: There is a critical need for climate-relevant experimental designs incorporating sustained thermal exposure and direct cortical readouts (e.g., TMS-EEG) in temperature-sensitive populations to elucidate mechanisms of thermal vulnerability.