ORIGINAL RESEARCH article
Front. Neurosci.
Sec. Brain Imaging Methods
Differential Cortical Responses to Neuromuscular Electrical versus Peripheral Magnetic Stimulation: A Multimodal TMS-fNIRS Study
Fengyun Yu 1
Weining Wang 2
Sijie Liang 3
Leyi Xu 1
Ruiping Hu 2
Yulian Zhu 2
1. The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
2. Huashan Hospital Fudan University, Shanghai, China
3. The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Abstract
Objective: To investigate cortical modulatory effects of neuromuscular electrical stimulation (NMES) and peripheral magnetic stimulation (PMS) applied to the wrist extensors of healthy adults, using fNIRS as the primary assessment modality. Methods: In a randomized crossover design, fifteen right-handed adults received NMES and PMS sessions (separated by ≥48 hours). Stimulation intensity was functionally calibrated to elicit a matched, maximal painless wrist dorsiflexion. Corticospinal excitability was assessed via motor evoked potentials (MEPs) before and after each intervention. Real-time cortical hemodynamics were monitored with functional near-infrared spectroscopy (fNIRS) during stimulation, quantifying changes in oxygenated ([HbO]) and deoxygenated ([HbR]) hemoglobin concentrations across the sensorimotor (SMC), prefrontal (PFC), and occipital (OC) cortices. Results: Neither NMES nor PMS induced significant changes in MEP amplitude (NMES: p=0.674; PMS: p=0.794). However, fNIRS revealed fundamentally distinct cortical activation patterns during stimulation. NMES was associated with widespread decreases in [HbO] within the PFC, ipsilateral SMC, and OC (p<0.05). In contrast, PMS elicited focal activation in the contralateral SMC, characterized by a significant increase in [HbO] (ch23: p=0.005; ch35: p=0.022) and a concurrent decrease in [HbR] (p<0.05) compared to the NMES condition. General linear model analysis confirmed more robust contralateral SMC activation during PMS. No significant differences in task-based functional connectivity were observed between the two modalities. Conclusions: A single session of NMES and PMS differentially modulates real-time cortical hemodynamics without altering corticospinal excitability. PMS induces focal, excitatory-dominant activation of the contralateral SMC, while NMES evokes a pattern of widespread cortical modulation, reflecting their distinct afferent mechanisms.
Summary
Keywords
cortical activity, cortical hemodynamics, functional near-infrared spectroscopy, neuromuscular electrical stimulation, Peripheral magnetic stimulation
Received
05 January 2026
Accepted
12 February 2026
Copyright
© 2026 Yu, Wang, Liang, Xu, Hu and Zhu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Yulian Zhu
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