The spatiotemporal evolution of TMS-evoked potentials reflects direct cortical activation

Transcranial Magnetic Stimulation (TMS) evokes electroencephalographic (EEG) responses that can persist for hundreds of milliseconds. While the first 80 ms after the pulse are widely accepted to reflect genuine cortical responses to TMS, later components have mainly been attributed to the effects of sensory co-stimulations. Here we reappraise this view by investigating the target-specificity of the spatiotemporal evolution of TMS-evoked potentials (TEPs). To this end, we compared TEPs elicited by targeting the premotor and primary motor cortices in 16 healthy subjects, under conditions designed to optimize TMS effectiveness on the cortex while minimizing peripheral confounds. As a counterfactual, we conducted the same comparison on the EEG responses evoked by realistic sham TMS and high-intensity somatosensory scalp stimulation. We found that EEG responses to motor and premotor TMS can exhibit distinct spatiotemporal evolutions, lasting up to 300 ms, both at the group and single-subject levels. These differences were absent or marginally detectable in both realistic sham TMS and high-intensity somatosensory scalp stimulation. Our findings suggest that, when effectiveness is optimized and peripheral confounds are controlled, TMS elicits specific long-lasting genuine EEG responses that reflect the initial engagement of specific cortical targets. These results challenge previous assumptions and highlight how TMS-EEG can be reliably used to assess large-scale properties within corticothalamic networks.