Journal
JOURNAL OF CLINICAL NEUROPHYSIOLOGY
Volume 30, Issue 4, Pages 390-395Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/WNP.0b013e31829dda6b
Keywords
Transcranial magnetic stimulation; Navigated brain stimulation; Current direction; Electromyography
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Funding
- National Center for Research Resources: Harvard-Thorndike General Clinical Research Center at BIDMC [NCRR MO1 RR01032]
- Harvard Clinical and Translational Science Center [UL1 RR025758]
- NIH [K24 RR018875]
- Nancy Lurie Marks Family Foundation
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The precision of navigated transcranial magnetic stimulation (TMS) to map the human primary motor cortex may be effected by the direction of TMS-induced current in the brain as determined by the orientation of the stimulation coil. In this study, the authors investigated the effect of current directionality on motor output mapping using navigated brain stimulation. The goal of this study was to determine the optimal coil orientation (and, thus, induced brain current) to activate hand musculature representations relative to each subject's unique neuroanatomical landmarks. The authors studied motor output maps for the first dorsal interosseous, abductor pollicis brevis, and abductor digiti minimi muscles in 10 normal volunteers. Monopolar current pulses were delivered through a figure-of-eight-shaped TMS coil, and motor evoked potentials were recorded using electromyography. At each targeted brain region, the authors systematically rotated the TMS coil to determine the direction of induced current in the brain for induction of the largest motor evoked potentials. These optimal current directions were expressed as an angle relative to each subject's central sulcus. Consistency of the optimal current direction was assessed by repeating the entire mapping procedure on two different occasions across subjects. The authors demonstrate that systematic optimization of current direction as guided by MRI-based neuronavigation improves the resolution of cortical output motor mapping with TMS.
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