Developmental models of motor-evoked potential features by transcranial magnetic stimulation across age groups from childhood to adulthood

MEPFeatX-automated feature extraction of motor-evoked potentials in transcranial magnetic stimulation

Motor evoked potentials (MEPs) are an important measure in transcranial magnetic stimulation (TMS) when assessing neuronal excitability in clinical diagnostics related to motor function, as well as in neuroscience research. However, manual feature extraction from large datasets can be time-consuming and prone to human error, and valuable features, such as MEP polyphasia and duration, are often neglected. Several packages have been developed to simplify the process; however, they are often tailored to specific studies or are not accessible. Here, we introduce MEPFeatX, a verified MATLAB package designed for automated and comprehensive MEP feature extraction across a wide range of stimulation paradigms. MEPFeatX is designed and documented for easy integration into any MEP analysis pipeline. Primed templates for specific paradigms, as well as additional analysis coded in R language, are also provided. Thus, MEPFeatX provides its users with a comprehensive and accurate set of MEP features, along with their visuals, facilitating quick and reliable MEP analysis in TMS studies.

Accurate determination of motor evoked potential amplitude in TMS: The impact of personal and experimental factors

OBJECTIVE

Corticospinal excitability can be quantified using motor-evoked potentials (MEP) following transcranial magnetic stimulation (TMS). However, the inherent variability of MEPs poses significant challenges. We establish a framework using personal and experimental factors to select the optimal number of trials (nopt) required for reliable MEP estimates.

METHODS

47 healthy younger underwent single-pulse TMS over the left primary motor cortex (M1). Per participant, 550 MEPs were collected at intensities ranging from 110 % to 150 % of the resting motor threshold (rMT), in 10 % increments. Per intensity, we calculated nopt. We analyzed which personal and experimental factors affected nopt.

RESULTS

nopt decreased with increasing TMS intensity, lower rMT baseline values, and exclusion of single-trial outliers. Sex had no significant effect.

CONCLUSIONS

Our study indicates that even when TMS is used as an outcome measure, custom-tailoring its protocol to study-related circumstances is key, as TMS intensity, outliers, baseline rMT, and the desired precision level affect the number of TMS trials needed to obtain a reliable MEP. Thus, we underscore the absence of a universal rule-of-thumb rule, although our predictive equations and online tool provide future TMS experimenters with the means to estimate the required number of TMS trials based on individual characteristics and specific experimental conditions.

SIGNIFICANCE

Our predictive equations offer a tailored approach for selecting nopt, enhancing the reliability of TMS-derived corticospinal excitability measurements.

Characteristics of motor evoked potentials in patients with peripheral vascular disease

With an aging population, it is common to encounter people diagnosed with peripheral vascular disease (PVD). Some will undergo surgeries during which the spinal cord may be compromised and intraoperative neuromonitoring with motor evoked potentials (MEPs) is employed to help mitigate paralysis. No data exist on characteristics of MEPs in older, PVD patients, which would be valuable for patients undergoing spinal cord at-risk surgery or participating in neurophysiological research. Transcranial magnetic stimulation, which can be delivered to the awake patient, was used to stimulate the motor cortex of 20 patients (mean (±SD)) age 63.2yrs (±11.5) with confirmed PVD, every 10 minutes for one hour with MEPs recorded from selected upper and lower limb muscles. Data were compared to that from 20 healthy volunteers recruited for a protocol development study (28yrs (±7.6)). MEPs did not differ between patient's symptomatic and asymptomatic legs. MEP amplitudes were not different for a given muscle between patients and healthy participants. Except for vastus lateralis, disease severity did not correlate with MEP amplitude. There were no differences over time in the coefficient of variation of MEP amplitude at each time point for any muscle in patients or in healthy participants. Although latencies of MEPs were not different between patients and healthy participants for a given muscle, they were longer in older participants. The results obtained suggest PVD alone does not impact MEPs; there were no differences between more symptomatic and less symptomatic legs. Further, in general, disease severity did not corelate with MEP characteristics. With an aging population, more patients with PVD and cardiovascular risk factors will be participating in neurophysiological studies or undergoing surgery where spinal cord integrity is monitored. Our data show that MEPs from these patients can be easily evoked and interpreted.

Home-based arm cycling exercise improves trunk control in persons with incomplete spinal cord injury: an observational study

Arm cycling is used for cardiorespiratory rehabilitation but its therapeutic effects on the neural control of the trunk after spinal cord injury (SCI) remain unclear. We investigated the effects of single session of arm cycling on corticospinal excitability, and the feasibility of home-based arm cycling exercise training on volitional control of the erector spinae (ES) in individuals with incomplete SCI. Using transcranial magnetic stimulation, we assessed motor evoked potentials (MEPs) in the ES before and after 30 min of arm cycling in 15 individuals with SCI and 15 able-bodied controls (Experiment 1). Both groups showed increased ES MEP size after the arm cycling. The participants with SCI subsequently underwent a 6-week home-based arm cycling exercise training (Experiment 2). MEP amplitudes and activity of the ES, and movements of the trunk during reaching, self-initiated rapid shoulder flexion, and predicted external perturbation tasks were measured. After the training, individuals with SCI reached further and improved trajectory of the trunk during the rapid shoulder flexion task, accompanied by increased ES activity and MEP amplitudes. Exercise adherence was excellent. We demonstrate preserved corticospinal drive after a single arm cycling session and the effects of home-based arm cycling exercise training on trunk function in individuals with SCI.