Refining Lower Limb TMS: Identifying MEPs in Resting Ipsilateral Muscles

For clinicians managing patients with neurological conditions like stroke or spinal cord injury, transcranial magnetic stimulation (TMS) provides a non-invasive window into corticospinal excitability and motor pathway integrity [1, 2, 3]. While established for many applications, its use for lower limb muscles presents distinct challenges due to their deeper cortical representation and greater signal variability [4, 5]. Optimizing the methodology for eliciting and quantifying motor evoked potentials (MEPs) in the legs is therefore a critical step toward improving diagnostic precision and guiding therapies aimed at enhancing gait and balance [6, 7]. Establishing robust, standardized protocols is essential to translate the full potential of TMS into reliable clinical measurements of lower limb cortical excitability and plasticity [8, 9, 10].