Predictive modeling of TMS-evoked responses: Unraveling instantaneous excitability states

Transcranial magnetic stimulation (TMS) combined with electroencephalography (EEG) and electromyography (EMG) provides a unique window into instantaneous cortical and corticospinal excitability states. We investigated 50 healthy participants to determine how fluctuations in pre-stimulus brain activity influence single-trial TMS-evoked potentials (TEPs) and motor-evoked potentials (MEPs). We developed a novel automated source-level TEP extraction method using individualized spatiotemporal priors that is robust against poor single-trial signal-to-noise ratios (SNRs) and ongoing oscillations. TEP and MEP amplitudes were predicted with linear mixed-effects models based on pre-stimulation EEG band-powers (theta to gamma), while accounting for temporal drifts (within-session trends), coil control, and inter-subject differences. We found that higher pre-stimulus sensorimotor alpha, beta, and gamma power were each associated with larger TEPs, indicating a more excitable cortical state. Increases in alpha and gamma power immediately before stimulation specifically predicted larger MEPs, reflecting increased corticospinal excitability. These results reveal relationships between ongoing oscillatory brain states and TMS response amplitudes, identifying EEG biomarkers of high- and low-excitability states. In conclusion, our study demonstrates the feasibility of single-trial source-level TMS–EEG analysis and shows that spontaneous alpha-, beta-, and gamma-band oscillations modulate motor cortical and corticospinal responsiveness. These findings pave the way for EEG-informed, brain-state-dependent TMS protocols to optimize neuromodulatory interventions in clinical and research applications.