"Non-invasive" brain stimulation is not non-invasive

Abstract

The functions of the healthy brain can be studied in two main ways. Firstly, the changes in the brain's state can be measured using techniques such as EEG or functional MRI. Secondly, the activity of the brain can be disrupted through the use of brain stimulation. The famous experiments of Wilder Penfield and colleagues in the 1950s showed the power of brain stimulation in people whose brain was exposed in surgery, and highlighted the possibility of inducing changes in the brain's state to demonstrate the involvement of specific brain areas in particular functions (Jasper and Penfield, 1954). Two main techniques are available for human brain stimulation: transcranial magnetic stimulation (TMS) and transcranial current stimulation (tCS). More recently, it has been suggested that TMS and tCS might be used to enhance brain function, as well as to disrupt activity. These techniques have collectively become known as “non-invasive brain stimulation.” We argue that this term is inappropriate and perhaps oxymoronic, as it obscures both the possibility of side-effects from the stimulation, and the longer-term effects (both adverse and desirable) that may result from brain stimulation. We also argue that the established tendency for the effects of TMS and tCS to spread from the target brain area to neighboring areas is in itself contrary to the definition of non-invasiveness. We argue that the traditional definition of an invasive procedure, one which requires an incision or insertion in the body, should be re-examined, and we propose that it be widened to include targeted transcutaneous interventions