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Roshchina KE, Bekyashev AK, Gasparyan TG, Aleshin VA, Osinov IK, Savateev AN, Khalafyan DA. Modern possibilities of neurosurgical treatment of brain metastases. Zh Vopr Neirokhir Im N N Burdenko 2022; 86:119-125. [PMID: 36252202 DOI: 10.17116/neiro202286051119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Despite significant progress in neuroimaging and introduction of new combined treatments for solid tumors, brain metastases are still adverse factor for overall survival. Brain metastases are diagnosed in 8-10% of patients and associated with extremely poor prognosis. These lesions result focal and general cerebral symptoms. Literature review highlights the current principles of surgical treatment of metastatic brain lesions in patients with solid tumors.
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Affiliation(s)
- K E Roshchina
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - A Kh Bekyashev
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - T G Gasparyan
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
- Scientific Center of Neurology, Moscow, Russia
| | - V A Aleshin
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - I K Osinov
- Burdenko Neurosurgical Center, Moscow, Russia
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Kornatz KW, Poston B, Stelmach GE. Age and Not the Preferred Limb Influences the Kinematic Structure of Pointing Movements. J Funct Morphol Kinesiol 2021; 6:jfmk6040100. [PMID: 34940509 PMCID: PMC8703669 DOI: 10.3390/jfmk6040100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 12/02/2022] Open
Abstract
In goal-directed movements, effective open-loop control reduces the need for feedback-based corrective submovements. The purpose of this study was to determine the influence of hand preference and aging on submovements during single- and two-joint pointing movements. A total of 12 young and 12 older right-handed participants performed pointing movements that involved either elbow extension or a combination of elbow extension and horizontal shoulder flexion with their right and left arms to a target. Kinematics were used to separate the movements into their primary and secondary submovements. The older adults exhibited slower movements, used secondary submovements more often, and produced relatively shorter primary submovements. However, there were no interlimb differences for either age group or for the single- and two-joint movements. These findings indicate that open-loop control is similar between arms but compromised in older compared to younger adults.
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Affiliation(s)
- Kurt W. Kornatz
- Department of Exercise Physiology, Winston-Salem State University, Winston-Salem, NC 27110, USA;
| | - Brach Poston
- Department of Kinesiology and Nutrition Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA
- Correspondence: ; Tel.: +1-702-895-5329
| | - George E. Stelmach
- Department of Kinesiology, Arizona State University, Tempe, AZ 85281, USA;
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Abstract
KEY POINTS The functional role of motor cortical reorganization following spinal cord injury (SCI) remains largely unknown. Here, we tested motor maps in a hand muscle at rest and during voluntary contraction of the hand with and without voluntary contraction of a proximal arm muscle. Motor map area in participants with SCI decreased during hand voluntary contraction and further decreased during additional contraction of a proximal arm muscle compared with rest. In contrast, motor map area in controls increased during the same motor tasks. Participants with SCI with more severe sensory deficits in the hand showed larger decreases in motor map area. Ten minutes of hand muscle-tendon vibration increased the motor map area during voluntary contraction in SCI participants. These novel findings suggest that abnormal changes in motor cortical maps during voluntary contraction after SCI can be reshaped by sensory input, knowledge that can have implications for rehabilitation. ABSTRACT Motor cortical representations reorganize following cervical spinal cord injury (SCI). The functional role of this reorganization remains largely unknown. Using neuronavigated transcranial magnetic stimulation, we examined motor cortical maps during voluntary contraction in humans with chronic cervical SCI and age-matched controls. We constructed motor maps in the first dorsal interosseous (FDI) muscle at rest and during voluntary contraction of the FDI with and without voluntary contraction of the biceps brachi (BB). The role of sensory input into this reorganization was examined by muscle-tendon vibration. We found that, at rest, motor maps were larger in SCI (22.3 cm2 ) compared with control (12.6 cm2 , P < 0.001) participants. Motor map area increased during voluntary contraction of the FDI (120.7%) and further increased during contraction of the BB (143.9%) compared with rest in control subjects; however, motor map area decreased during voluntary contraction of the FDI (69.5%) and further decreased during contraction of the BB (55.5%) in individuals with SCI. SCI participants with larger decreases in map area during voluntary contraction of the FDI were those with larger sensory deficits in the hand and 10 min of hand muscle-tendon vibration increased motor map area. These results provide the first evidence of abnormal changes in motor cortical maps in humans with chronic SCI during voluntary contraction, suggesting that sensory input can help to reshape this reorganization.
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Affiliation(s)
- Toshiki Tazoe
- Arms + Hands Lab, Shirley Ryan AbilityLab, Northwestern
University, Chicago, IL 60611 and Hines Veterans Affairs Medical Center, Chicago, IL
60141, USA
- Neural Prosthesis Project, Department of Brain and
Neurosciences, Tokyo Metropolitan Institute of Medial Science, Tokyo 156-8506,
Japan
| | - Monica A. Perez
- Arms + Hands Lab, Shirley Ryan AbilityLab, Northwestern
University, Chicago, IL 60611 and Hines Veterans Affairs Medical Center, Chicago, IL
60141, USA
- The Miami Project to Cure Paralysis, Department of
Neurological Surgery, University of Miami, Miami FL 33136 and Bruce W. Carter
Department of Veterans Affairs Medical Center, Miami, FL 33125, USA
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Mori H, Kagaya H, Inamoto Y, Izumi SI, Yashima K, Takagi T. Numerical Analysis of Eddy Current Distribution in Submental Region Induced by Magnetic Stimulation for Treating Dysphagia. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1178-1186. [PMID: 32191893 DOI: 10.1109/tnsre.2020.2981399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Induced contraction of the suprahyoid muscles via magnetic stimulation is considered to be effective for the rehabilitation of dysphagia. In our previous study, a magnetic stimulation coil with a U-shaped core for stimulating the suprahyoid muscles was developed based on the results of numerical analysis using a simplified human head model. It was confirmed that magnetic stimulation by the coil causes large contraction of the muscles. However, the human head has a complex structure that includes bone structures through which current cannot easily pass. To accurately predict the current density distribution induced by magnetic stimulation, a model that accurately describes the human head is required for numerical analysis. Therefore, in this study, numerical analysis using the finite element method with a human head model that includes the bone structure obtained from computed tomography scans was performed. The results for the model with bone structure show that the coil with a U-shaped core can stimulate the motor points of the suprahyoid muscles in the middle of the submental region. When compared with the current density observed in a model without the bone structure, that in the model with the bone structure was reduced by 29% at a point 20 mm below the mandibular surface. It is thus necessary to perform a numerical analysis using a model with the bone structure to obtain accurate analysis results.
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Nicolini C, Harasym D, Turco CV, Nelson AJ. Human motor cortical organization is influenced by handedness. Cortex 2019; 115:172-183. [PMID: 30826624 DOI: 10.1016/j.cortex.2019.01.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/29/2018] [Accepted: 01/10/2019] [Indexed: 11/28/2022]
Abstract
Although there is some evidence that handedness is associated with structural and functional differences in the motor cortex, findings remain inconclusive. Here, we evaluated whether handedness influences the location, size and overlap of the cortical representations of upper limb muscles across hemispheres in right- versus left-handed individuals. Using transcranial magnetic stimulation, the cortical representations of abductor pollicis brevis, flexor carpi radialis and biceps brachii muscles were mapped bilaterally with a 6 by 5 grid space. Results indicate that right-handers had more lateral and posterior representations in the non-dominant hemisphere as well as greater overall cortical territory compared to left-handers. Right- and left-handers did not differ in the extent of overlap between muscle representations. Our findings suggest that human motor cortical organization of upper limb muscles is indeed influenced by handedness, specifically with regard to the location of non-dominant cortical muscle representations and the size of cortical territory dedicated to upper limb muscle representations.
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Affiliation(s)
- Chiara Nicolini
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada.
| | - Diana Harasym
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
| | - Claudia V Turco
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada.
| | - Aimee J Nelson
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada; School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
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Seynaeve L, Haeck T, Gramer M, Maes F, De Vleeschouwer S, Van Paesschen W. Optimized preoperative motor cortex mapping in brain tumors using advanced processing of transcranial magnetic stimulation data. Neuroimage Clin 2019; 21:101657. [PMID: 30660662 PMCID: PMC6413351 DOI: 10.1016/j.nicl.2019.101657] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/21/2018] [Accepted: 01/03/2019] [Indexed: 11/18/2022]
Abstract
Background and objective Transcranial magnetic stimulation (TMS) is a useful technique to help localize motor function prior to neurosurgical procedures. Adequate modelling of the effect of TMS on the brain is a prerequisite to obtain reliable data. Methods Twelve patients were included with perirolandic tumors to undergo TMS-based motor mapping. Several models were developed to analyze the mapping data, from a projection to the nearest brain surface to motor evoked potential (MEP) amplitude informed weighted average of the induced electric fields over a multilayer detailed individual head model. The probability maps were compared with direct cortical stimulation (DCS) data in all patients for the hand and in three for the foot. The gold standard was defined as the results of the DCS sampling (with on average 8 DCS-points per surgery) extrapolated over the exposed cortex (of the tailored craniotomy), and the outcome parameters were based on the similarity of the probability maps with this gold standard. Results All models accurately gauge the location of the motor cortex, with point-cloud based mapping algorithms having an accuracy of 83–86%, with similarly high specificity. To delineate the whole area of the motor cortex representation, the model based on the weighted average of the induced electric fields calculated with a realistic head model performs best. The optimal single threshold to visualize the field based maps is 40% of the maximal value for the anisotropic model and 50% for the isotropic model, but dynamic thresholding adds information for clinical practice. Conclusions The method with which TMS mapping data are analyzed clearly affects the predicted area of the primary motor cortex representation. Realistic electric field based modelling is feasible in clinical practice and improves delineation of the motor cortex representation compared to more simple point-cloud based methods. Probability maps of the motor cortex representation were created from a TMS mapping. The MEP-weighted averaged tissue specific induced fields based map performed best. This map can gauge both motor cortex outline and hotspot, by varying the threshold.
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Affiliation(s)
- Laura Seynaeve
- Laboratory for Epilepsy Research, KU Leuven, Herestraat 49, Box 7003, 3000 Leuven, Belgium.
| | - Tom Haeck
- Department ESAT-PSI, KU Leuven, Kasteelpark Arenberg 10, Box 2441, 3001 Leuven, Belgium; Medical Imaging Research Center, UZ Leuven, Herestraat 49, Box 7003, 3000 Leuven, Belgium
| | - Markus Gramer
- Department ESAT-PSI, KU Leuven, Kasteelpark Arenberg 10, Box 2441, 3001 Leuven, Belgium; Medical Imaging Research Center, UZ Leuven, Herestraat 49, Box 7003, 3000 Leuven, Belgium
| | - Frederik Maes
- Department ESAT-PSI, KU Leuven, Kasteelpark Arenberg 10, Box 2441, 3001 Leuven, Belgium; Medical Imaging Research Center, UZ Leuven, Herestraat 49, Box 7003, 3000 Leuven, Belgium.
| | - Steven De Vleeschouwer
- Department of Neurosurgery, UZ Leuven, Laboratory for Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Herestraat 49, Box 7003, 3000 Leuven, Belgium.
| | - Wim Van Paesschen
- Laboratory for Epilepsy Research, KU Leuven, Herestraat 49, Box 7003, 3000 Leuven, Belgium; Department of Neurology, UZ Leuven, Belgium.
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Fassett HJ, Turco CV, El-Sayes J, Nelson AJ. Alterations in Motor Cortical Representation of Muscles Following Incomplete Spinal Cord Injury in Humans. Brain Sci 2018; 8:E225. [PMID: 30558361 PMCID: PMC6316395 DOI: 10.3390/brainsci8120225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/07/2018] [Accepted: 12/14/2018] [Indexed: 12/03/2022] Open
Abstract
(1) Background: The primary motor cortex (M1) experiences reorganization following spinal cord injury (SCI). However, there is a paucity of research comparing bilateral M1 organization in SCI and questions remain to be answered. We explored the presence of somatotopy within the M1 representation of arm muscles, and determined whether anatomical shifts in these representations occur, and investigated the symmetry in organization between the two hemispheres.; (2) Methods: Transcranial magnetic stimulation (TMS) was used to map the representation of the biceps, flexor carpi radialis and abductor pollicis brevis (APB) bilaterally in nine individuals with chronic incomplete cervical spinal cord injury and nine aged- and handed-matched uninjured controls. TMS was delivered over a 6 × 5 point grid that encompassed M1 using an intensity specific to the resting motor threshold for each muscle tested.; (3) Results: Results indicate that, compared to controls, muscle representations in SCI are shifted medially but preserve a general somatotopic arrangement, and that territory dedicated to the APB muscle is greater.; (4) Conclusions: These findings demonstrate differences in the organization of M1 between able-bodied controls and those with incomplete cervical SCI. This altered organization may have future implications in understanding the functional deficits observed in SCI and rehabilitation techniques aimed at restoring function.
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Affiliation(s)
- Hunter J Fassett
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - Claudia V Turco
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - Jenin El-Sayes
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - Aimee J Nelson
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4L8, Canada.
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Abstract
Surgery, stereotactic radiosurgery, radiotherapy, and chemotherapy including novel targeted therapy strategies and any combination thereof as well as supportive care are the key elements for treatment of brain metastases. Goals of microsurgery are to obtain tissue samples for histologic diagnosis (particularly in case of uncertainty about the unknown primary tumor but also in the context of future targeted therapies), to relieve burden from space-occupying effects, to improve local tumor control, and to prolong overall survival. Complete surgical resection improves local tumor control and may even affect overall survival. Stereotactic radiosurgery is an equal effective alternative for metastases up to 3 cm in diameter, especially in highly eloquent or deep seated location. Gross total resection (as defined by immediate postoperative MRI) does not necessarily have to be combined with whole brain radiotherapy (WBRT), at least for patients with good performance status and controlled systemic disease. Particularly in cases of incomplete resections, focal irradiation or radiosurgery of the resection cavity or tumor remnant rather than WBRT may be attempted.
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Affiliation(s)
- Niklas Thon
- Department of Neurosurgery, University of Munich LMU, Munich, Germany
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Kaye HL, Gersner R, Boes AD, Pascual-Leone A, Rotenberg A. Persistent uncrossed corticospinal connections in patients with intractable focal epilepsy. Epilepsy Behav 2017; 75:66-71. [PMID: 28830029 PMCID: PMC5882467 DOI: 10.1016/j.yebeh.2017.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/07/2017] [Accepted: 07/07/2017] [Indexed: 01/28/2023]
Abstract
Corticospinal connections may be bilateral at birth, but a predominantly unilateral and crossed pattern develops by the toddler years. Acquired injury can alter the normal development of laterality such that uncrossed corticospinal connections persist, particularly if the injury is early in life and involves the motor system. Whether other developmental insults, such as childhood epilepsy, affect the development of crossed laterality in the motor system is unknown, although this topic has relevance for understanding the broader impact of epilepsy on brain development. Accordingly, in a cohort of children with intractable focal epilepsy, we tested by neuronavigated transcranial magnetic stimulation (nTMS) whether childhood epilepsy is associated with persistent uncrossed corticospinal connections. Specifically, we hypothesized that in contrast to early-life neuroclastic corticospinal tract injury that induces preservation of uncrossed corticospinal connections in the contralesional hemisphere, uncrossed corticospinal connections will be preserved in the epileptic hemisphere where the corticospinal tract is intact, but overstimulated by ongoing seizures and epileptic interictal discharges. Motor cortex mapping was performed by nTMS as part of a clinical presurgical evaluation, and the analysis was limited to patients with radiographically intact motor cortices and corticospinal tracts. Given that foot motor cortex representation is often bilateral, we focused on the lateralization for the tibialis anterior muscle cortical motor representation and its relation to the seizure focus. We demonstrate preserved uncrossed corticospinal connections for the tibialis anterior region of the hemisphere affected by the epilepsy. These findings indicate a pathologically preserved immature motor lateralization in patients with epilepsy and suggest that developmental processes associated with hemispheric lateralization are affected by epilepsy.
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Affiliation(s)
- Harper L Kaye
- Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA, USA; F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA
| | - Roman Gersner
- Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA, USA; F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA
| | - Aaron D Boes
- Neuromodulation Program, Division of Pediatric Neurology, Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alexander Rotenberg
- Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA, USA; F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Kallioniemi E, Pitkänen M, Könönen M, Vanninen R, Julkunen P. Localization of cortical primary motor area of the hand using navigated transcranial magnetic stimulation, BOLD and arterial spin labeling fMRI. J Neurosci Methods 2016; 273:138-148. [PMID: 27615740 DOI: 10.1016/j.jneumeth.2016.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 07/12/2016] [Accepted: 09/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although the relationship between neuronavigated transcranial magnetic stimulation (nTMS) and functional magnetic resonance imaging (fMRI) has been widely studied in motor mapping, it is unknown how the motor response type or the choice of motor task affect this relationship. NEW METHOD Centers of gravity (CoGs) and response maxima were measured with blood-oxygen-level dependent (BOLD) and arterial spin labeling (ASL) fMRI during motor tasks against nTMS CoGs and response maxima, which were mapped with motor evoked potentials (MEPs) and silent periods (SPs). RESULTS No differences in motor representations (CoGs and response maxima) were observed in lateral-medial direction (p=0.265). fMRI methods localized the motor representation more posterior than nTMS (p<0.001). This was not affected by the BOLD fMRI motor task (p>0.999) nor nTMS response type (p>0.999). ASL fMRI maxima did not differ from the nTMS nor BOLD fMRI CoGs (p≥0.070), but the ASL CoG was deeper in comparison to other methods (p≤0.042). The BOLD fMRI motor task did not influence the depth of the motor representation (p≥0.745). The median Euclidean distances between the nTMS and fMRI motor representations varied between 7.7mm and 14.5mm and did not differ between the methods (F≤1.23, p≥0.318). COMPARISON WITH EXISTING METHODS The relationship between fMRI and nTMS mapped excitatory (MEP) and inhibitory (SP) responses, and whether the choice of motor task affects this relationship, have not been studied before. CONCLUSIONS The congruence between fMRI and nTMS is good. The choice of nTMS motor response type nor BOLD fMRI motor task had no effect on this relationship.
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Affiliation(s)
- Elisa Kallioniemi
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland; Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - Minna Pitkänen
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Mervi Könönen
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland; Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Petro Julkunen
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland; Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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Lefaucheur JP, Picht T. The value of preoperative functional cortical mapping using navigated TMS. Neurophysiol Clin 2016; 46:125-33. [PMID: 27229765 DOI: 10.1016/j.neucli.2016.05.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 05/02/2016] [Indexed: 01/29/2023] Open
Abstract
The surgical removal of brain tumours in so-called eloquent regions is frequently associated with a high risk of causing disabling postoperative deficits. Among the preoperative techniques proposed to help neurosurgical planning and procedure, navigated transcranial magnetic stimulation (nTMS) is increasingly performed. A high level of evidence is now available in the literature regarding the anatomical and functional accuracy of this mapping technique. This article presents the principles and facts demonstrating the value of using nTMS in clinical practice to preserve motor or language functions from deleterious lesions secondary to brain tumour resection or epilepsy surgery.
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Abstract
Functional magnetic resonance imaging (fMRI) maps the spatiotemporal distribution of neural activity in the brain under varying cognitive conditions. Since its inception in 1991, blood oxygen level-dependent (BOLD) fMRI has rapidly become a vital methodology in basic and applied neuroscience research. In the clinical realm, it has become an established tool for presurgical functional brain mapping. This chapter has three principal aims. First, we review key physiologic, biophysical, and methodologic principles that underlie BOLD fMRI, regardless of its particular area of application. These principles inform a nuanced interpretation of the BOLD fMRI signal, along with its neurophysiologic significance and pitfalls. Second, we illustrate the clinical application of task-based fMRI to presurgical motor, language, and memory mapping in patients with lesions near eloquent brain areas. Integration of BOLD fMRI and diffusion tensor white-matter tractography provides a road map for presurgical planning and intraoperative navigation that helps to maximize the extent of lesion resection while minimizing the risk of postoperative neurologic deficits. Finally, we highlight several basic principles of resting-state fMRI and its emerging translational clinical applications. Resting-state fMRI represents an important paradigm shift, focusing attention on functional connectivity within intrinsic cognitive networks.
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Affiliation(s)
- Bradley R Buchbinder
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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DaSilva AF, Truong DQ, DosSantos MF, Toback RL, Datta A, Bikson M. State-of-art neuroanatomical target analysis of high-definition and conventional tDCS montages used for migraine and pain control. Front Neuroanat 2015; 9:89. [PMID: 26236199 PMCID: PMC4502355 DOI: 10.3389/fnana.2015.00089] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/23/2015] [Indexed: 12/31/2022] Open
Abstract
Although transcranial direct current stimulation (tDCS) studies promise to modulate cortical regions associated with pain, the electric current produced usually spreads beyond the area of the electrodes' placement. Using a forward-model analysis, this study compared the neuroanatomic location and strength of the predicted electric current peaks, at cortical and subcortical levels, induced by conventional and High-Definition-tDCS (HD-tDCS) montages developed for migraine and other chronic pain disorders. The electrodes were positioned in accordance with the 10-20 or 10-10 electroencephalogram (EEG) landmarks: motor cortex-supraorbital (M1-SO, anode and cathode over C3 and Fp2, respectively), dorsolateral prefrontal cortex (PFC) bilateral (DLPFC, anode over F3, cathode over F4), vertex-occipital cortex (anode over Cz and cathode over Oz), HD-tDCS 4 × 1 (one anode on C3, and four cathodes over Cz, F3, T7, and P3) and HD-tDCS 2 × 2 (two anodes over C3/C5 and two cathodes over FC3/FC5). M1-SO produced a large current flow in the PFC. Peaks of current flow also occurred in deeper brain structures, such as the cingulate cortex, insula, thalamus and brainstem. The same structures received significant amount of current with Cz-Oz and DLPFC tDCS. However, there were differences in the current flow to outer cortical regions. The visual cortex, cingulate and thalamus received the majority of the current flow with the Cz-Oz, while the anterior parts of the superior and middle frontal gyri displayed an intense amount of current with DLPFC montage. HD-tDCS montages enhanced the focality, producing peaks of current in subcortical areas at negligible levels. This study provides novel information regarding the neuroanatomical distribution and strength of the electric current using several tDCS montages applied for migraine and pain control. Such information may help clinicians and researchers in deciding the most appropriate tDCS montage to treat each pain disorder.
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Affiliation(s)
- Alexandre F. DaSilva
- Headache and Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences and Michigan Center for Oral Health Research (MCOHR), School of Dentistry, University of MichiganAnn Arbor, MI, USA
| | - Dennis Q. Truong
- Department of Biomedical Engineering, The City College of New YorkNew York, NY, USA
| | - Marcos F. DosSantos
- Headache and Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences and Michigan Center for Oral Health Research (MCOHR), School of Dentistry, University of MichiganAnn Arbor, MI, USA
- Campus Macaé, Universidade Federal do Rio de Janeiro (UFRJ)Rio de Janeiro, Rio de Janeiro, Brasil
| | - Rebecca L. Toback
- Headache and Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences and Michigan Center for Oral Health Research (MCOHR), School of Dentistry, University of MichiganAnn Arbor, MI, USA
| | | | - Marom Bikson
- Department of Biomedical Engineering, The City College of New YorkNew York, NY, USA
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Pitkänen M, Kallioniemi E, Julkunen P. Extent and Location of the Excitatory and Inhibitory Cortical Hand Representation Maps: A Navigated Transcranial Magnetic Stimulation Study. Brain Topogr 2015; 28:657-665. [PMID: 26133678 DOI: 10.1007/s10548-015-0442-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 06/24/2015] [Indexed: 01/16/2023]
Abstract
Voluntary muscle action and control are modulated by the primary motor cortex, which is characterized by a well-defined somatotopy. Muscle action and control depend on a sensitive balance between excitatory and inhibitory mechanisms in the cortex and in the corticospinal tract. The cortical locations evoking excitatory and inhibitory responses in brain stimulation can be mapped, for example, as a pre-surgical procedure. The purpose of this study was to find the differences between excitatory and inhibitory motor representations mapped using navigated transcranial magnetic stimulation (nTMS). The representations of small hand muscles were mapped to determine the areas and the center of gravities (CoGs) in both hemispheres of healthy right-handed volunteers. The excitatory representations were obtained via resting motor evoked potential (MEP) mapping, with and without a stimulation grid. The inhibitory representations were mapped using the grid and measuring corticospinal silent periods (SPs) during voluntary muscle contraction. The excitatory representations were larger on the dominant hemisphere compared with the non-dominant (p < 0.05). The excitatory CoGs were more medial (p < 0.001) and anterior (p < 0.001) than the inhibitory CoGs. The use of the grid did not influence the areas or the CoGs. The results support the common hypothesis that the MEP and SP representations are located at adjacent sites. Furthermore, the dominant hemisphere seems to be better organized for controlling excitatory motor functions with respect to TMS. In addition, the inhibitory representations could provide further information about motor reorganization and aid in surgery planning when the functional cortical representations are located in abnormal cortical regions.
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Affiliation(s)
- Minna Pitkänen
- Department of Clinical Neurophysiology, Kuopio University Hospital, POB 100, 70029, KYS, Finland. .,Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, POB 12200, 00076, Aalto, Finland.
| | - Elisa Kallioniemi
- Department of Clinical Neurophysiology, Kuopio University Hospital, POB 100, 70029, KYS, Finland.,Department of Applied Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
| | - Petro Julkunen
- Department of Clinical Neurophysiology, Kuopio University Hospital, POB 100, 70029, KYS, Finland.,Department of Applied Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
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Könönen M, Tamsi N, Säisänen L, Kemppainen S, Määttä S, Julkunen P, Jutila L, Äikiä M, Kälviäinen R, Niskanen E, Vanninen R, Karjalainen P, Mervaala E. Non-invasive mapping of bilateral motor speech areas using navigated transcranial magnetic stimulation and functional magnetic resonance imaging. J Neurosci Methods 2015; 248:32-40. [DOI: 10.1016/j.jneumeth.2015.03.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 03/26/2015] [Accepted: 03/27/2015] [Indexed: 10/23/2022]
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Rossini PM, Burke D, Chen R, Cohen LG, Daskalakis Z, Di Iorio R, Di Lazzaro V, Ferreri F, Fitzgerald PB, George MS, Hallett M, Lefaucheur JP, Langguth B, Matsumoto H, Miniussi C, Nitsche MA, Pascual-Leone A, Paulus W, Rossi S, Rothwell JC, Siebner HR, Ugawa Y, Walsh V, Ziemann U. Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee. Clin Neurophysiol 2015; 126:1071-1107. [PMID: 25797650 PMCID: PMC6350257 DOI: 10.1016/j.clinph.2015.02.001] [Citation(s) in RCA: 1684] [Impact Index Per Article: 187.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 01/22/2015] [Accepted: 02/01/2015] [Indexed: 12/14/2022]
Abstract
These guidelines provide an up-date of previous IFCN report on “Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application” (Rossini et al., 1994). A new Committee, composed of international experts, some of whom were in the panel of the 1994 “Report”, was selected to produce a current state-of-the-art review of non-invasive stimulation both for clinical application and research in neuroscience. Since 1994, the international scientific community has seen a rapid increase in non-invasive brain stimulation in studying cognition, brain–behavior relationship and pathophysiology of various neurologic and psychiatric disorders. New paradigms of stimulation and new techniques have been developed. Furthermore, a large number of studies and clinical trials have demonstrated potential therapeutic applications of non-invasive brain stimulation, especially for TMS. Recent guidelines can be found in the literature covering specific aspects of non-invasive brain stimulation, such as safety (Rossi et al., 2009), methodology (Groppa et al., 2012) and therapeutic applications (Lefaucheur et al., 2014). This up-dated review covers theoretical, physiological and practical aspects of non-invasive stimulation of brain, spinal cord, nerve roots and peripheral nerves in the light of more updated knowledge, and include some recent extensions and developments.
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Affiliation(s)
- P M Rossini
- Institute of Neurology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Policlinic A. Gemelli, Rome, Italy
| | - D Burke
- Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - R Chen
- Division of Neurology, Toronto Western Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - L G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, NIH, Bethesda, MD, USA
| | - Z Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - R Di Iorio
- Institute of Neurology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Policlinic A. Gemelli, Rome, Italy.
| | - V Di Lazzaro
- Department of Neurology, University Campus Bio-medico, Rome, Italy
| | - F Ferreri
- Department of Neurology, University Campus Bio-medico, Rome, Italy; Department of Clinical Neurophysiology, University of Eastern Finland, Kuopio, Finland
| | - P B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred, Melbourne, Australia
| | - M S George
- Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - M Hallett
- Human Motor Control Section, Medical Neurology Branch, NINDS, NIH, Bethesda, MD, USA
| | - J P Lefaucheur
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - B Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - H Matsumoto
- Department of Neurology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - C Miniussi
- Department of Clinical and Experimental Sciences University of Brescia, Brescia, Italy; IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - M A Nitsche
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - A Pascual-Leone
- Berenson-Allen Center for Non-invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - W Paulus
- Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany
| | - S Rossi
- Brain Investigation & Neuromodulation Lab, Unit of Neurology and Clinical Neurophysiology, Department of Neuroscience, University of Siena, Siena, Italy
| | - J C Rothwell
- Institute of Neurology, University College London, London, United Kingdom
| | - H R Siebner
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Y Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - V Walsh
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - U Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
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Rizzo V, Terranova C, Conti A, Germanò A, Alafaci C, Raffa G, Girlanda P, Tomasello F, Quartarone A. Preoperative functional mapping for rolandic brain tumor surgery. Neurosci Lett 2014; 583:136-41. [DOI: 10.1016/j.neulet.2014.09.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/05/2014] [Accepted: 09/08/2014] [Indexed: 11/16/2022]
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Morecraft RJ, Stilwell-Morecraft KS, Solon-Cline KM, Ge J, Darling WG. Cortical innervation of the hypoglossal nucleus in the non-human primate (Macaca mulatta). J Comp Neurol 2014; 522:3456-84. [PMID: 24752643 PMCID: PMC4139435 DOI: 10.1002/cne.23614] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 01/06/2023]
Abstract
The corticobulbar projection to the hypoglossal nucleus was studied from the frontal, parietal, cingulate, and insular cortices in the rhesus monkey by using high-resolution anterograde tracers and stereology. The hypoglossal nucleus received bilateral input from the face/head region of the primary (M1), ventrolateral pre- (LPMCv), supplementary (M2), rostral cingulate (M3), and caudal cingulate (M4) motor cortices. Additional bilateral corticohypoglossal projections were found from the dorsolateral premotor cortex (LPMCd), ventrolateral proisocortical motor area (ProM), ventrolateral primary somatosensory cortex (S1), rostral insula, and pregenual region of the anterior cingulate gyrus (areas 24/32). Dense terminal projections arose from the ventral region of M1, and moderate projections from LPMCv and rostral part of M2, with considerably fewer hypoglossal projections arising from the other cortical regions. These findings demonstrate that extensive regions of the non-human primate cerebral cortex innervate the hypoglossal nucleus. The widespread and bilateral nature of this corticobulbar connection suggests recovery of tongue movement after cortical injury that compromises a subset of these areas, may occur from spared corticohypoglossal projection areas located on the lateral, as well as medial surfaces of both hemispheres. Since functional imaging studies have shown that homologous cortical areas are activated in humans during tongue movement tasks, these corticobulbar projections may exist in the human brain.
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Affiliation(s)
- Robert J. Morecraft
- Division of Basic Biomedical Sciences, Laboratory of Neurological Sciences, The University of South Dakota, Sanford School of Medicine, Vermillion, South Dakota 57069
| | - Kimberly S. Stilwell-Morecraft
- Division of Basic Biomedical Sciences, Laboratory of Neurological Sciences, The University of South Dakota, Sanford School of Medicine, Vermillion, South Dakota 57069
| | - Kathryn M. Solon-Cline
- Division of Basic Biomedical Sciences, Laboratory of Neurological Sciences, The University of South Dakota, Sanford School of Medicine, Vermillion, South Dakota 57069
| | - Jizhi Ge
- Division of Basic Biomedical Sciences, Laboratory of Neurological Sciences, The University of South Dakota, Sanford School of Medicine, Vermillion, South Dakota 57069
| | - Warren G. Darling
- Department of Health and Human Physiology, Motor Control Laboratories, The University of Iowa, Iowa City, Iowa 52242
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Krieg SM, Shiban E, Buchmann N, Meyer B, Ringel F. Presurgical navigated transcranial magnetic brain stimulation for recurrent gliomas in motor eloquent areas. Clin Neurophysiol 2013; 124:522-7. [DOI: 10.1016/j.clinph.2012.08.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 08/05/2012] [Accepted: 08/09/2012] [Indexed: 11/26/2022]
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Krieg SM, Schnurbus L, Shiban E, Droese D, Obermueller T, Buchmann N, Gempt J, Meyer B, Ringel F. Surgery of highly eloquent gliomas primarily assessed as non-resectable: risks and benefits in a cohort study. BMC Cancer 2013; 13:51. [PMID: 23374675 PMCID: PMC3583679 DOI: 10.1186/1471-2407-13-51] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 01/30/2013] [Indexed: 01/17/2023] Open
Abstract
Background Today, the treatment of choice for high- and low-grade gliomas requires primarily surgical resection to achieve the best survival and quality of life. Nevertheless, many gliomas within highly eloquent cortical regions, e.g., insula, rolandic, and left perisylvian cortex, still do not undergo surgery because of the impending risk of surgery-related deficits at some centers. However, pre and intraoperative brain mapping, intraoperative neuromonitoring (IOM), and awake surgery increase safety, which allows resection of most of these tumors with a considerably low rate of postoperatively new deficits. Methods Between 2006 and 2012, we resected 47 out of 51 supratentorial gliomas (92%), which were primarily evaluated to be non-resectable during previous presentation at another neurosurgical department. Out of these, 25 were glioblastomas WHO grade IV (53%), 14 were anaplastic astrocytomas WHO grade III (30%), 7 were diffuse astrocytomas WHO grade II (15%), and one was a pilocytic astrocytoma WHO grade I (2%). All data, including pre and intraoperative brain mapping and monitoring (IOM) by motor evoked potentials (MEPs) were reviewed and related to the postoperative outcome. Results Awake surgery was performed in 8 cases (17%). IOM was required in 38 cases (81%) and was stable in 18 cases (47%), whereas MEPs changed the surgical strategy in 10 cases (26%). Thereby, gross total resection was achieved in 35 cases (74%). Postoperatively, 17 of 47 patients (36%) had a new motor or language deficit, which remained permanent in 8.5% (4 patients). Progression-free follow-up was 11.3 months (range: 2 weeks – 64.5 months) and median survival was 14.8 months (range: 4 weeks – 20.5 months). Median Karnofsky Performance Scale was 85 before and 80 after surgery). Conclusions In specialized centers, most highly eloquent gliomas are eligible for surgical resection with an acceptable rate of surgery-related deficits; therefore, they should be referred to specialized centers.
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Affiliation(s)
- Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str, 22, 81675, Munich, Germany.
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Ferreri F, Rossini PM. TMS and TMS-EEG techniques in the study of the excitability, connectivity, and plasticity of the human motor cortex. Rev Neurosci 2013; 24. [DOI: 10.1515/revneuro-2013-0019] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/04/2013] [Indexed: 11/15/2022]
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Abstract
There have been inconsistencies in the literature regarding asymmetrical neural control and results of experiments using TMS techniques. Therefore, the aim of this study was to further our understanding of the neural relationships that may underlie performance asymmetry with respect to the distal muscles of the hand using a TMS stimulus-response curve technique. Twenty-four male subjects (12 right handed, 12 left handed) participated in a TMS stimulus-response (S-R) curve trial. Focal TMS was applied over the motor cortex to find the optimal position for the first dorsal interossei muscle and to determine rest threshold (RTh). Seven TMS intensities ranging from 90 to 150 % of RTh were delivered in 10 % increments. One single TMS block consisted of 16 stimuli at each intensity. Peak-to-peak amplitudes were measured and the S-R curve generated. In right-handed subjects, the mean difference in slopes between the right and left hand was -0.011 ± 0.03, while the mean difference between hands in left-handed subjects was -0.049 ± 0.08. Left-handed normalized data in right handers displayed a mean of 1.616 ± 1.019 (two-tailed t test p < 0.05). The left-handed group showed a significant change in the normalized slope as indicated by a mean of 1.693 ± 0.149 (two-tailed t test p < 0.00006). The results found in this study reinforce previous work which suggests that there is an asymmetry in neural drive that exists in both left- and right-handed individuals. However, the results show that the non-dominant motor hemisphere displays a greater amount of excitability than the dominant, which goes against the conventional dogma. This asymmetry indicates that the non-dominant hemisphere may have a higher level of excitation or a lower level of inhibition for both groups of participants.
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Affiliation(s)
- Julian Daligadu
- Department of Health Sciences, Division of Kinesiology and Human Motor Learning, University of Ontario Institute of Technology, 2000 Simcoe St North, Oshawa, ON, Canada
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Krieg SM, Shiban E, Buchmann N, Gempt J, Foerschler A, Meyer B, Ringel F. Utility of presurgical navigated transcranial magnetic brain stimulation for the resection of tumors in eloquent motor areas. J Neurosurg 2012; 116:994-1001. [DOI: 10.3171/2011.12.jns111524] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Navigated transcranial magnetic stimulation (nTMS) is a newly evolving technique. Despite its supposed purpose (for example, preoperative central region mapping), little is known about its accuracy compared with established modalities like direct cortical stimulation (DCS) and functional MR (fMR) imaging. Against this background, the authors performed the current study to compare the accuracy of nTMS with DCS and fMR imaging.
Methods
Fourteen patients with tumors in or close to the precentral gyrus were examined using nTMS for motor cortex mapping, as were 12 patients with lesions in the subcortical white matter motor tract. Moreover, preoperative fMR imaging and intraoperative mapping of the motor cortex were performed via DCS, and the outlining of the motor cortex was compared.
Results
In the 14 cases of lesions affecting the precentral gyrus, the primary motor cortex as outlined by nTMS correlated well with that delineated by intraoperative DCS mapping, with a deviation of 4.4 ± 3.4 mm between the two methods. In comparing nTMS with fMR imaging, the deviation between the two methods was much larger: 9.8 ± 8.5 mm for the upper extremity and 14.7 ± 12.4 mm for the lower extremity. In 13 of 14 cases, the surgeon admitted easier identification of the central region because of nTMS. The procedure had a subjectively positive influence on the operative results in 5 cases and was responsible for a changed resection strategy in 2 cases. One of 26 patients experienced nTMS as unpleasant; none found it painful.
Conclusions
Navigated TMS correlates well with DCS as a gold standard despite factors that are supposed to contribute to the inaccuracy of nTMS. Moreover, surgeons have found nTMS to be an additional and helpful modality during the resection of tumors affecting eloquent motor areas, as well as during preoperative planning.
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Affiliation(s)
| | | | | | | | - Annette Foerschler
- 2Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Germany
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Diekhoff S, Uludağ K, Sparing R, Tittgemeyer M, Cavuşoğlu M, von Cramon DY, Grefkes C. Functional localization in the human brain: Gradient-Echo, Spin-Echo, and arterial spin-labeling fMRI compared with neuronavigated TMS. Hum Brain Mapp 2011; 32:341-57. [PMID: 20533563 DOI: 10.1002/hbm.21024] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A spatial mismatch of up to 14 mm between optimal transcranial magnetic stimulation (TMS) site and functional magnetic resonance imaging (fMRI) signal has consistently been reported for the primary motor cortex. The underlying cause might be the effect of magnetic susceptibility around large draining veins in Gradient-Echo blood oxygenation level-dependent (GRE-BOLD) fMRI. We tested whether alternative fMRI sequences such as Spin-Echo (SE-BOLD) or Arterial Spin-Labeling (ASL) assessing cerebral blood flow (ASL-CBF) may localize neural activity closer to optimal TMS positions and primary motor cortex than GRE-BOLD. GRE-BOLD, SE-BOLD, and ASL-CBF signal changes during right thumb abductions were obtained from 15 healthy subjects at 3 Tesla. In 12 subjects, tissue at fMRI maxima was stimulated with neuronavigated TMS to compare motor-evoked potentials (MEPs). Euclidean distances between the fMRI center-of-gravity (CoG) and the TMS motor mapping CoG were calculated. Highest SE-BOLD and ASL-CBF signal changes were located in the anterior wall of the central sulcus [Brodmann Area 4 (BA4)], whereas highest GRE-BOLD signal changes were significantly closer to the gyral surface. TMS at GRE-BOLD maxima resulted in higher MEPs which might be attributed to significantly higher electric field strengths. TMS-CoGs were significantly anterior to fMRI-CoGs but distances were not statistically different across sequences. Our findings imply that spatial differences between fMRI and TMS are unlikely to be caused by spatial unspecificity of GRE-BOLD fMRI but might be attributed to other factors, e.g., interactions between TMS-induced electric field and neural tissue. Differences between techniques should be kept in mind when using fMRI coordinates as TMS (intervention) targets.
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Affiliation(s)
- Svenja Diekhoff
- Max Planck Institute for Neurological Research, Cologne, Germany
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Gabarrós A, Martino J, Plans G, Godino O, Torres A, Aparicio A, Acebes J, Juncadella M, Pujol R, Deus J, Conesa G. Identificación intraoperatoria del área motora suplementaria en cirugía neurooncológica. Neurocirugia (Astur) 2011; 22:123-32. [DOI: 10.1016/s1130-1473(11)70010-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Radman T, Ramos RL, Brumberg JC, Bikson M. Role of cortical cell type and morphology in subthreshold and suprathreshold uniform electric field stimulation in vitro. Brain Stimul 2010; 2:215-28, 228.e1-3. [PMID: 20161507 DOI: 10.1016/j.brs.2009.03.007] [Citation(s) in RCA: 406] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The neocortex is the most common target of subdural electrotherapy and noninvasive brain stimulation modalities, including transcranial magnetic stimulation (TMS) and transcranial current simulation (TCS). Specific neuronal elements targeted by cortical stimulation are considered to underlie therapeutic effects, but the exact cell type(s) affected by these methods remains poorly understood. OBJECTIVE We determined whether neuronal morphology or cell type predicted responses to subthreshold and suprathreshold uniform electric fields. METHODS We characterized the effects of subthreshold and suprathreshold electrical stimulation on identified cortical neurons in vitro. Uniform electric fields were applied to rat motor cortex brain slices, while recording from interneurons and pyramidal cells across cortical layers, using a whole-cell patch clamp. Neuron morphology was reconstructed after intracellular dialysis of biocytin. Based solely on volume-weighted morphology, we developed a parsimonious model of neuronal soma polarization by subthreshold electric fields. RESULTS We found that neuronal morphology correlated with somatic subthreshold polarization. Based on neuronal morphology, we predict layer V pyramidal neuronal soma to be individually the most sensitive to polarization by optimally oriented subthreshold fields. Suprathreshold electric field action potential threshold was shown to reflect both direct cell polarization and synaptic (network) activation. Layer V/VI neuron absolute electric field action potential thresholds were lower than layer II/III pyramidal neurons and interneurons. Compared with somatic current injection, electric fields promoted burst firing and modulated action potential firing times. CONCLUSIONS We present experimental data indicating that cortical neuron morphology relative to electric fields and cortical cell type are factors in determining sensitivity to sub- and supra-threshold brain stimulation.
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Affiliation(s)
- Thomas Radman
- Department of Biomedical Engineering, City College of the City University of New York, New York, New York, USA
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Kantelhardt SR, Fadini T, Finke M, Kallenberg K, Siemerkus J, Bockermann V, Matthaeus L, Paulus W, Schweikard A, Rohde V, Giese A. Robot-assisted image-guided transcranial magnetic stimulation for somatotopic mapping of the motor cortex: a clinical pilot study. Acta Neurochir (Wien) 2010; 152:333-43. [PMID: 19943069 PMCID: PMC2815301 DOI: 10.1007/s00701-009-0565-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 11/03/2009] [Indexed: 11/28/2022]
Abstract
Purpose Shape and exact location of motor cortical areas varies among individuals. The exact knowledge of these locations is crucial for planning of neurosurgical procedures. In this study, we have used robot-assisted image-guided transcranial magnetic stimulation (Ri-TMS) to elicit MEP response recorded for individual muscles and reconstruct functional motor maps of the primary motor cortex. Methods One healthy volunteer and five patients with intracranial tumors neighboring the precentral gyrus were selected for this pilot study. Conventional MRI and fMRI were obtained. Transcranial magnetic stimulation was performed using a MagPro X100 stimulator and a standard figure-of-eight coil positioned by an Adept Viper s850 robot. The fMRI activation/Ri-TMS response pattern were compared. In two cases, Ri-TMS was additionally compared to intraoperative direct electrical cortical stimulation. Results Maximal MEP response of the m. abductor digiti minimi was located in an area corresponding to the “hand knob” of the precentral gyrus for both hemispheres. Repeated Ri-TMS measurements showed a high reproducibility. Simultaneous registration of the MEP response for m. brachioradialis, m. abductor pollicis brevis, and m. abductor digiti minimi demonstrated individual peak areas of maximal MEP response for the individual muscle groups. Ri-TMS mapping was compared to the corresponding fMRI studies. The areas of maximal MEP response localized within the “finger tapping” activated areas by fMRI in all six individuals. Conclusions Ri-TMS is suitable for high resolution non-invasive preoperative somatotopic mapping of the motor cortex. Ri-TMS may help in the planning of neurosurgical procedures and may be directly used in navigation systems.
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Affiliation(s)
- Sven Rainer Kantelhardt
- Department of Neurosurgery, Georg-August University of Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - Tommaso Fadini
- Department of Clinical Neurophysiology, Georg-August University of Göttingen, Göttingen, Germany
| | - Markus Finke
- Institute for Robotics und Cognitive Systems, University of Lübeck, Lübeck, Germany
| | - Kai Kallenberg
- Department of Neuroradiology, Georg-August University of Göttingen, Göttingen, Germany
- MR-Research in Neurology and Psychiatry, Georg-August University of Göttingen, Göttingen, Germany
| | - Jakob Siemerkus
- MR-Research in Neurology and Psychiatry, Georg-August University of Göttingen, Göttingen, Germany
| | - Volker Bockermann
- Department of Neurosurgery, Georg-August University of Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - Lars Matthaeus
- Institute for Robotics und Cognitive Systems, University of Lübeck, Lübeck, Germany
| | - Walter Paulus
- Department of Clinical Neurophysiology, Georg-August University of Göttingen, Göttingen, Germany
| | - Achim Schweikard
- Institute for Robotics und Cognitive Systems, University of Lübeck, Lübeck, Germany
| | - Veit Rohde
- Department of Neurosurgery, Georg-August University of Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - Alf Giese
- Department of Neurosurgery, Georg-August University of Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
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LIVINGSTON SCOTTC, INGERSOLL CHRISTOPHERD. INTRA-RATER RELIABILITY OF A TRANSCRANIAL MAGNETIC STIMULATION TECHNIQUE TO OBTAIN MOTOR EVOKED POTENTIALS. Int J Neurosci 2009; 118:239-56. [DOI: 10.1080/00207450701668020] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sack AT, Cohen Kadosh R, Schuhmann T, Moerel M, Walsh V, Goebel R. Optimizing functional accuracy of TMS in cognitive studies: a comparison of methods. J Cogn Neurosci 2009; 21:207-21. [PMID: 18823235 DOI: 10.1162/jocn.2009.21126] [Citation(s) in RCA: 275] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Transcranial magnetic stimulation (TMS) is a tool for inducing transient disruptions of neural activity noninvasively in conscious human volunteers. In recent years, the investigative domain of TMS has expanded and now encompasses causal structure-function relationships across the whole gamut of cognitive functions and associated cortical brain regions. Consequently, the importance of how to determine the target stimulation site has increased and a number of alternative methods have emerged. Comparison across studies is precluded because different studies necessarily use different tasks, sites, TMS conditions, and have different goals. Here, therefore, we systematically compare four commonly used TMS coil positioning approaches by using them to induce behavioral change in a single cognitive study. Specifically, we investigated the behavioral impact of right parietal TMS during a number comparison task, while basing TMS localization either on (i) individual fMRI-guided TMS neuronavigation, (ii) individual MRI-guided TMS neuronavigation, (iii) group functional Talairach coordinates, or (iv) 10-20 EEG position P4. We quantified the exact behavioral effects induced by TMS using each approach, calculated the standardized experimental effect sizes, and conducted a statistical power analysis in order to calculate the optimal sample size required to reveal statistical significance. Our findings revealed a systematic difference between the four approaches, with the individual fMRI-guided TMS neuronavigation yielding the strongest and the P4 stimulation approach yielding the smallest behavioral effect size. Accordingly, power analyses revealed that although in the fMRI-guided neuronavigation approach five participants were sufficient to reveal a significant behavioral effect, the number of necessary participants increased to n = 9 when employing MRI-guided neuronavigation, to n = 13 in case of TMS based on group Talairach coordinates, and to n = 47 when applying TMS over P4. We discuss these graded effect size differences in light of the revealed interindividual variances in the actual target stimulation site within and between approaches.
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Vitikainen AM, Lioumis P, Paetau R, Salli E, Komssi S, Metsähonkala L, Paetau A, Kičić D, Blomstedt G, Valanne L, Mäkelä J, Gaily E. Combined use of non-invasive techniques for improved functional localization for a selected group of epilepsy surgery candidates. Neuroimage 2009; 45:342-8. [DOI: 10.1016/j.neuroimage.2008.12.026] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 11/04/2008] [Accepted: 12/08/2008] [Indexed: 11/27/2022] Open
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Borghetti D, Sartucci F, Petacchi E, Guzzetta A, Piras MF, Murri L, Cioni G. Transcranial magnetic stimulation mapping: a model based on spline interpolation. Brain Res Bull 2008; 77:143-8. [PMID: 18588952 DOI: 10.1016/j.brainresbull.2008.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Revised: 05/30/2008] [Accepted: 06/03/2008] [Indexed: 11/28/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive method to investigate motor pathways and to create a map of the somatotopical organization of the motor cortex: ordinary mapping procedures requires a focal brain stimulation over different spots of the scalp and electromyographic (EMG) recording from a muscle. Finding an appropriate and a valid visual representation of collected data is a crucial step in research and clinical field to allow a relatively fast, intra- and inter-patient comparison of motor cortex mapping. Aim of this study was to develop and to validate a method to map cortical representation of an intrinsic hand muscle (abductor digiti minimi, ADM) using a two-dimensional spline interpolation of EMG peak amplitudes obtained with TMS. The interpolated model will result in a graphical colour-scaled representation of the motor cortex for the investigated muscle; fitted model was finally validated by comparing derived parameters with those directly measured to ensure the strength and reliability of the model. Ten healthy volunteers (mean age+/-S.D.: 35.3+/-4.7 years, 4 males and 6 females) were enrolled in the study. Transcranial stimulation was performed by placing a figure-of-eight coil over a predefined grid on the scalp of the subject. EMG responses were recorded from the right abductor digiti minimi (ADM): averaged EMG peak amplitudes obtained at each node were then used to perform spline interpolation and to derive other parameters like center of gravity (CoG). Arithmetical mean of all resting motor threshold at the hotspot was 50.6+/-3.4% of the maximal stimulator output. Average amplitude at the hotspot was 1.72+/-0.80 mV and its coordinates, expressed as median, were x=4.5 cm and y=0.0 cm. Mean CoG was located at x=4.86+/-0.57 cm and y=0.35+/-0.10 cm. Mean interpolated peak coordinates for ADM were xf=4.86+/-0.58 cm and yf=0.36+/-0.12 cm, while mean fitted peak amplitude was 0.87+/-0.47 mV. Results suggest how it is possible to map the primary motor cortex using two-dimensional spline interpolation of peak-to-peak amplitudes obtained by single pulse TMS delivered on several scalp positions, which will result in a smooth, easy to read, colour-scaled map. However, like other visual representation modalities, the interpolation should become complementary to traditional methods and not a substitute of a precise and accurate cortical motor mapping.
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Affiliation(s)
- D Borghetti
- Department of Neuroscience, Clinical Neurology, University of Pisa, Italy
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Forner-Cordero A, Steyvers M, Levin O, Alaerts K, Swinnen SP. Changes in corticomotor excitability following prolonged muscle tendon vibration. Behav Brain Res 2008; 190:41-9. [PMID: 18378327 DOI: 10.1016/j.bbr.2008.02.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Revised: 01/13/2008] [Accepted: 02/04/2008] [Indexed: 11/28/2022]
Affiliation(s)
- Arturo Forner-Cordero
- Motor Control Laboratory, Department of Biomedical Kinesiology, Group Biomedical Sciences, Katholieke Universiteit Leuven, Belgium.
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Z'Graggen WJ, Humm AM, Oppliger-Bachmann S, Hosang M, Rösler KM. Repetitive spinal motor neuron discharges following single transcranial magnetic stimulation: relation to dexterity. Exp Brain Res 2008; 188:579-87. [PMID: 18463857 DOI: 10.1007/s00221-008-1389-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 04/13/2008] [Indexed: 10/22/2022]
Abstract
Transcranial magnetic stimulation allows to study the properties of the human corticospinal tract non-invasively. After a single transcranial magnetic stimulus, spinal motor neurons (MNs) sometimes fire not just once, but repetitively. The biological significance of such repetitive MN discharges (repMNDs) is unknown. To study the relation of repMNDs to other measures of cortico-muscular excitability and to physiological measures of the skill for finely tuned precision movements, we used a previously described quadruple stimulation (QuadS) technique (Z'Graggen et al. 2005) to quantify the amount of repMNDs in abductor digiti minimi muscles (ADMs) on both sides of 20 right-handed healthy subjects. Skillfulness for finger precision movements of both hands was assessed using a finger tapping task. In 16 subjects, a follow-up examination was performed after training of either precision movements (n = 8) or force (n = 8) of the left ADM. The size of the QuadS response (amplitude and area ratios) was greater in the dominant right hand than in the left hand (QuadS amplitude ratio: 47.1 +/- 18.1 versus 37.7 +/- 22.0%, Wilcoxon test: P < 0.05; QuadS area ratio: 49.7 +/- 16.2% versus 36.9 +/- 23.0%, Wilcoxon test: P < 0.05), pointing to a greater amount of repMNDs. Moreover, the QuadS amplitude and area increased significantly after finger precision training, but not after force training. This increase of repMNDs correlated significantly with the increase in performance in the finger tapping task. Our results demonstrate that repMNDs are related to handedness and therefore probably reflect supraspinal excitability differences. The increase of repMNDs after skills training but not after force training supports the hypothesis of a supraspinal origin of repMNDs.
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Datta A, Elwassif M, Battaglia F, Bikson M. Transcranial current stimulation focality using disc and ring electrode configurations: FEM analysis. J Neural Eng 2008; 5:163-74. [PMID: 18441418 DOI: 10.1088/1741-2560/5/2/007] [Citation(s) in RCA: 203] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We calculated the electric fields induced in the brain during transcranial current stimulation (TCS) using a finite-element concentric spheres human head model. A range of disc electrode configurations were simulated: (1) distant-bipolar; (2) adjacent-bipolar; (3) tripolar; and three ring designs, (4) belt, (5) concentric ring, and (6) double concentric ring. We compared the focality of each configuration targeting cortical structures oriented normal to the surface ('surface-radial' and 'cross-section radial'), cortical structures oriented along the brain surface ('surface-tangential' and 'cross-section tangential') and non-oriented cortical surface structures ('surface-magnitude' and 'cross-section magnitude'). For surface-radial fields, we further considered the 'polarity' of modulation (e.g. superficial cortical neuron soma hyper/depolarizing). The distant-bipolar configuration, which is comparable with commonly used TCS protocols, resulted in diffuse (un-focal) modulation with bi-directional radial modulation under each electrode and tangential modulation between electrodes. Increasing the proximity of the two electrodes (adjacent-bipolar electrode configuration) increased focality, at the cost of more surface current. At similar electrode distances, the tripolar-electrodes configuration produced comparable peak focality, but reduced radial bi-directionality. The concentric-ring configuration resulted in the highest spatial focality and uni-directional radial modulation, at the expense of increased total surface current. Changing ring dimensions, or use of two concentric rings, allow titration of this balance. The concentric-ring design may thus provide an optimized configuration for targeted modulation of superficial cortical neurons.
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Affiliation(s)
- Abhishek Datta
- Department of Biomedical Engineering, The City College of New York of the City University of New York, NY 10031, USA
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Wagner T, Eden U, Fregni F, Valero-Cabre A, Ramos-Estebanez C, Pronio-Stelluto V, Grodzinsky A, Zahn M, Pascual-Leone A. Transcranial magnetic stimulation and brain atrophy: a computer-based human brain model study. Exp Brain Res 2008; 186:539-50. [PMID: 18193208 DOI: 10.1007/s00221-007-1258-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2006] [Accepted: 12/14/2007] [Indexed: 01/30/2023]
Abstract
This paper is aimed at exploring the effect of cortical brain atrophy on the currents induced by transcranial magnetic stimulation (TMS). We compared the currents induced by various TMS conditions on several different MRI derived finite element head models of brain atrophy, incorporating both decreasing cortical volume and widened sulci. The current densities induced in the cortex were dependent upon the degree and type of cortical atrophy and were altered in magnitude, location, and orientation when compared to healthy head models. Predictive models of the degree of current density attenuation as a function of the scalp-to-cortex distance were analyzed, concluding that those which ignore the electromagnetic field-tissue interactions lead to inaccurate conclusions. Ultimately, the precise site and population of neural elements stimulated by TMS in an atrophic brain cannot be predicted based on healthy head models which ignore the effects of the altered cortex on the stimulating currents. Clinical applications of TMS should be carefully considered in light of these findings.
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Affiliation(s)
- Tim Wagner
- Division of Health Sciences and Technology, Harvard Medical School/Massachusetts Institute of Technology, Boston, MA, USA.
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Sparing R, Buelte D, Meister IG, Paus T, Fink GR. Transcranial magnetic stimulation and the challenge of coil placement: a comparison of conventional and stereotaxic neuronavigational strategies. Hum Brain Mapp 2008; 29:82-96. [PMID: 17318831 PMCID: PMC6871049 DOI: 10.1002/hbm.20360] [Citation(s) in RCA: 207] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Revised: 11/13/2006] [Accepted: 12/07/2006] [Indexed: 11/07/2022] Open
Abstract
The combination of transcranial magnetic stimulation (TMS) with functional neuroimaging has expanded the potential of TMS for human brain mapping. The precise and reliable positioning of the TMS coil is not a simple task, however. Modern frameless stereotaxic systems allow investigators to base navigation either on the subject's structural magnetic resonance imaging (MRI), functional MRI data, or the use of functional neuroimaging data from the literature, so-called "probabilistic approach." The latter assumes consistency across individuals in the location of task-related "activations" in standardized stereotaxic space. Conventional nonstereotaxic localization of brain areas is also a common method for defining the coil position. Our aim was to evaluate the accuracy of five different localization strategies in one single study. The left primary motor cortex (left M1-Hand) was used as target region. Three approaches were based on real-time frameless stereotaxy using information based on either anatomical or functional MRI. The remaining two strategies relied either on standard cranial landmarks (i.e., the International 10-20 EEG system) or a standardized function-guided procedure (i.e., the spatial relationship between the left and right M1-Hand). The results were compared to a TMS-based mapping of the primary motor cortex; center of gravity of motor-evoked potentials (MEP-CoG) was calculated for each subject (n = 10). Our findings suggest that highest precision can be achieved with fMRI-guided stimulation, which was accurate within the range of millimeters. Very consistent results were also obtained with the "probabilistic" approach. In view of these findings, we discuss the methods and special characteristics of each localization strategy.
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Affiliation(s)
- Roland Sparing
- Department of Medicine, Institute of Neuroscience and Biophysics, Research Center Juelich, Juelich, Germany.
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Goble DJ, Brown SH. The biological and behavioral basis of upper limb asymmetries in sensorimotor performance. Neurosci Biobehav Rev 2008; 32:598-610. [DOI: 10.1016/j.neubiorev.2007.10.006] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 09/26/2007] [Accepted: 10/28/2007] [Indexed: 11/20/2022]
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De Lucia M, Parker GJM, Embleton K, Newton JM, Walsh V. Diffusion tensor MRI-based estimation of the influence of brain tissue anisotropy on the effects of transcranial magnetic stimulation. Neuroimage 2007; 36:1159-70. [PMID: 17524673 DOI: 10.1016/j.neuroimage.2007.03.062] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2006] [Revised: 03/21/2007] [Accepted: 03/26/2007] [Indexed: 10/23/2022] Open
Abstract
We evaluate and discuss the relevance of fiber anisotropy in estimating the effect of transcranial magnetic stimulation (TMS) on the human brain. Finite element simulations were carried out on a three-dimensional model of the head that included anisotropic conductivity information derived from diffusion tensor imaging (DTI). The results show that anisotropy has minor effects both on the position of the main locus of activation and on its intensity. It has considerably more effect on the spatial distribution of the induced electric field, yielding differences of the order of 10% of the maximum induced field. Moreover the area affected by magnetic stimulation is slightly larger when we include fiber anisotropy in the calculations than in an isotropic model. We also show that the induced field observed in the anisotropic model does not always align with the local fiber orientation but rather follows specific patterns of parallelity. These findings will help to improve the estimation of the areas involved in magnetic stimulation.
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Affiliation(s)
- M De Lucia
- Department of Medical Physics, University College London, London, UK.
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Lehéricy S, Duffau H, Van de Moortele P, Delmaire C. Validity of Presurgical Functional Localization. In: Stippich C, editor. Clinical Functional MRI. Berlin: Springer Berlin Heidelberg; 2007. pp. 167-87. [DOI: 10.1007/978-3-540-49976-3_7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Abstract
Since the birth of functional magnetic resonance imaging (fMRI)-a noninvasive tool able to visualize brain function-now 15 years ago, several clinical applications have emerged. fMRI follows from the neurovascular coupling between neuronal electrical activity and cerebrovascular physiology that leads to three effects that can contribute to the fMRI signal: an increase in the blood flow velocity, in the blood volume and in the blood oxygenation level. The latter effect, gave the technique the name blood oxygenation level dependent (BOLD) fMRI. One of the major clinical uses is presurgical fMRI in patients with brain abnormalities. The goals of presurgical fMRI are threefold: 1) assessing the risk of neurological deficit that follows a surgical procedure, 2) selecting patients for invasive intraoperative mapping, and 3) guiding of the surgical procedure itself. These are reviewed here. Unfortunately, randomized trials or outcome studies that definitively show benefits to the final outcome of the patient when applying fMRI presurgically have not been performed. Therefore, fMRI has not yet reached the status of clinical acceptance. The final purpose of this article is to define a roadmap of future research and developments in order to tilt pre-surgical fMRI to the status of clinical validity and acceptance.
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Affiliation(s)
- Stefan Sunaert
- Department of Radiology, University Hospital of the Catholic University of Leuven, Leuven, Belgium.
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Korvenoja A, Kirveskari E, Aronen HJ, Avikainen S, Brander A, Huttunen J, Ilmoniemi RJ, Jääskeläinen JE, Kovala T, Mäkelä JP, Salli E, Seppä M. Sensorimotor Cortex Localization: Comparison of Magnetoencephalography, Functional MR Imaging, and Intraoperative Cortical Mapping. Radiology 2006; 241:213-22. [PMID: 16908676 DOI: 10.1148/radiol.2411050796] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate magnetoencephalography (MEG) and functional magnetic resonance (MR) imaging, as compared with intraoperative cortical mapping, for identification of the central sulcus. MATERIALS AND METHODS Fifteen patients (six men, nine women; age range, 25-58 years) with a lesion near the primary sensorimotor cortex (13 gliomas, one cavernous hemangioma, and one meningioma) were examined after institutional review board approval and written informed consent from each patient were obtained. At MEG, evoked magnetic fields to median nerve stimulation were recorded; at functional MR imaging, hemodynamic responses to self-paced palmar flexion of the wrist were imaged. General linear model analysis with contextual clustering (P < .01) was used to analyze functional MR imaging data, and dipole modeling was used to analyze MEG data. MEG and functional MR localizations were compared with intraoperative cortical mappings. The distance from the area of functional MR imaging activation to the tumor margin was compared between the patients with discordant and those with concordant intraoperative mapping findings by using unpaired t testing. RESULTS MEG depicted the central sulcus correctly in all 15 patients, as verified at intraoperative mapping. The functional MR imaging localization results agreed with the intraoperative mappings in 11 patients. In all four patients with a false localization, the primary activation was in the postcentral sulcus region, but it did not differ significantly from the primary activation in the patients with correct localization with respect to proximity to the tumor (P = .38). Furthermore, at functional MR imaging, multiple nonprimary areas were activated, with considerable interindividual variation. CONCLUSION Although both MEG and functional MR imaging can provide useful information for neurosurgical planning, in the present study, MEG proved to be superior for locating the central sulcus. Activation of multiple nonprimary cerebral areas may confound the interpretation of functional MR imaging results.
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Affiliation(s)
- Antti Korvenoja
- Functional Brain Imaging Unit, Helsinki Brain Research Center, Medical Imaging Center, University of Helsinki, Helsinki, Finland.
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Abstract
Subcortical band heterotopia is a diffuse malformation of cortical development related to pharmacologically intractable epilepsy. On magnetic resonance imaging (MRI), patients with "double cortex" syndrome (DCS) present with a band of heterotopic gray matter separated from the overlying cortex by a layer of white matter. The function and connectivity of the subcortical heterotopic band in humans is only partially understood. We studied six DCS patients with bilateral subcortical band heterotopias and six healthy controls using functional MRI (fMRI). In controls, simple motor task elicited contralateral activation of the primary motor cortex (M1) and ipsilateral activation of the cerebellum and left supplementary motor area (SMA). All DCS patients showed task-related contralateral activation of both M1 and the underlying heterotopic band. Ipsilateral motor activation was seen in 4/6 DCS patients. Furthermore, there were additional activations of nonprimary normotopic cortical areas. The sensory stimulus resulted in activation of the contralateral primary sensory cortex (SI) and the thalamus in all healthy subjects. The left sensory task also induced a contralateral activation of the insular cortex. Sensory activation of the contralateral SI was seen in all DCS patients and secondary somatosensory areas in 5/6. The heterotopic band beneath SI became activated in 3/6 DCS patients. Activations were also seen in subcortical structures for both paradigms. In DCS, motor and sensory tasks induce an activation of the subcortical heterotopic band. The recruitment of bilateral primary areas and higher-order association normotopic cortices indicates the need for a widespread network to perform simple tasks.
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Affiliation(s)
- Jeffrey D. Jirsch
- Montreal Neurological Institute and Hospital, Department of Neurology, McGill University, Montreal, Quebec, Canada
| | - Neda Bernasconi
- Montreal Neurological Institute and Hospital, Department of Neurology, McGill University, Montreal, Quebec, Canada
| | | | - Paolo Vitali
- National Neurologic Institute Carlo Besta, Milan, Italy
| | | | - Andrea Bernasconi
- Montreal Neurological Institute and Hospital, Department of Neurology, McGill University, Montreal, Quebec, Canada
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Abstract
Focal cortical dysplasia (FCD) is a common cause of pharmacoresistant epilepsy that is amenable to surgical resective treatment. The identification of structural FCD by magnetic resonance imaging (MRI) can contribute to the detection of the epileptogenic zone and improve the outcome of epilepsy surgery. MR epilepsy protocols that include specific T1 and T2 weighted, and fluid-attenuated inversion recovery (FLAIR) sequences give complementary information about the characteristic imaging features of FCD; focal cortical thickening, blurring of the gray-white junction, high FLAIR signal, and gyral anatomical abnormalities. Novel imaging techniques such as magnetic resonance spectroscopy (MRS), magnetization transfer imaging (MTI), and diffusion tensor imaging (DTI) can improve the sensitivity of MR to localize the anatomical lesion. Functional/metabolic techniques such as positron emission tomography (PET), ictal subtraction single photon emission computed tomography (SPECT), functional MRI (fMRI), and magnetic source imaging (MSI) have the potential to visualize the metabolic, vascular, and epileptogenic properties of the FCD lesion, respectively. Identification of eloquent areas of cortex, to assist in the surgical resection plan, can be obtained non-invasively through the use of fMRI and MSI. Although a significant number of FCD lesions remain unidentified using current neuroimaging techniques, future advances should result in the identification of an increasing number of these cortical malformations.
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Affiliation(s)
- Peter Widdess-Walsh
- Section of Adult Epilepsy and Clinical Neurophysiology, The Cleveland Clinic Epilepsy Center, Cleveland, OH 44195, USA
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Berry I, Roux FE, Boulanouar K, Ranjeva JP, Ibarrola D, Manelfe C. IRM fonctionnelle de l'encéphale : principes et principaux résultats des nouvelles techniques. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s1879-8551(06)73999-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Denslow S, Bohning DE, Bohning PA, Lomarev MP, George MS. An increased precision comparison of TMS-induced motor cortex BOLD fMRI response for image-guided versus function-guided coil placement. Cogn Behav Neurol 2005; 18:119-26. [PMID: 15970732 DOI: 10.1097/01.wnn.0000160821.15459.68] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine with high precision the differences between function-guided and image-guided transcranial magnetic stimulation (TMS). METHOD Using a calibrated TMS coil holder/positioner, interleaved TMS/functional magnetic resonance imaging (fMRI), and individualized anatomy-based regional normalization, we conducted a two-phase study of TMS coil positioning guided by either function (elicited thumb motion) or image-based targeting of the "hand knob," the anatomy associated with fMRI activation during thumb motion. RESULTS In every case, image-guided TMS coil placement produced a thumb movement response at thresholds similar to those found under function guidance. Unexpectedly, function-guided coil locations clustered bimodally over central and precentral sulci. Image-guided locations clustered as anticipated toward the targeted gyral crown. Despite these differences, blood oxygenation level-dependent (BOLD) activation locations and magnitude for the two methods displayed no consistent differences in mean or variance between or within subjects. Image guidance produced more consistent coil placement from subject to subject relative to targeted anatomy. Surprisingly, BOLD time courses from image-guided experiments showed significantly slower return to baseline after TMS than was observed under function guidance. CONCLUSIONS The results demonstrate the effectiveness and precision of image-guided positioning of TMS coils combined with a precisely adjustable holder/positioner and regional normalization. Image guidance provides an accurate TMS placement relative to individual anatomy when no external sign is available.
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Affiliation(s)
- Stewart Denslow
- Department of Radiology, Center for Advanced Imaging Research and Brain Stimulation Laboratories, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Niyazov DM, Butler AJ, Kadah YM, Epstein CM, Hu XP. Functional magnetic resonance imaging and transcranial magnetic stimulation: effects of motor imagery, movement and coil orientation. Clin Neurophysiol 2005; 116:1601-10. [PMID: 15953559 DOI: 10.1016/j.clinph.2005.02.028] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2004] [Revised: 01/18/2005] [Accepted: 02/21/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare fMRI activations during movement and motor imagery to corresponding motor evoked potential (MEP) maps obtained with the TMS coil in three different orientations. METHODS fMRI activations during executed (EM) and imagined (IM) movements of the index finger were compared to MEP maps of the first dorsal interosseus (FDI) muscle obtained with the TMS coil in anterior, posterior and lateral handle positions. To ensure spatial registration of fMRI and MEP maps, a special grid was used in both experiments. RESULTS No statistically significant difference was found between the TMS centers of gravity (TMS CoG) obtained with the three coil orientations. There was a significant difference between fMRI centers of gravity during IMs (IM CoG) and EMs (EM CoG), with IM CoGs localized on average 10.3mm anterior to those of EMs in the precentral gyrus. Most importantly, the IM CoGs closely matched cortical projections of the TMS CoGs while the EM CoGs were on average 9.5mm posterior to the projected TMS CoGs. CONCLUSIONS TMS motor maps are more congruent with fMRI activations during motor imagery than those during EMs. These findings are not significantly affected by changing orientation of the TMS coil. SIGNIFICANCE Our results suggest that the discrepancy between fMRI and TMS motor maps may be largely due to involvement of the somatosensory component in the EM task.
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Affiliation(s)
- D M Niyazov
- Department of Biomedical Engineering, Emory University School of Medicine, Hospital Annex, 531 Asbury Circle, Suite N305, Atlanta, GA 30322, USA.
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Kim D, Shin M, Lee K, Chu K, Woo SH, Kim YR, Song E, Lee J, Park S, Roh J. Musical training-induced functional reorganization of the adult brain: functional magnetic resonance imaging and transcranial magnetic stimulation study on amateur string players. Hum Brain Mapp 2005; 23:188-99. [PMID: 15449354 PMCID: PMC6871859 DOI: 10.1002/hbm.20058] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We used the combined technique of functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) to observe changes that occur in adult brains after the practice of stringed musical instruments. We carried out fMRI on eight volunteers (aged 20-22 years): five novices and three individuals who had discontinued practice for more than 5 years. The motor paradigm contained a repetitive lift-abduction/fall-adduction movement of the left/right little finger, carried out with maximum efforts without pacing. The sensory paradigm was to stimulate the same little finger using a string. In parallel to the fMRI acquisition, TMS motor maps for the little finger were obtained using a frameless stereotactic neuronavigation system. After the baseline study, each participant began to learn a stringed instrument. Newly developed fMRI activations for the left little finger were observed 6 months after practice at multiple brain regions including inferior parietal lobule, premotor area (PMA), left precuneus, right anterior superior temporal gyrus, and posterior middle temporal gyrus. In contrast, new activations were rarely observed for the right little finger. The TMS study revealed new motor representation sites for the left little finger in the PMA or supplementary motor area (SMA). Unexpectedly, TMS motor maps for the right little finger were reduced significantly. Among new fMRI activations for sensory stimuli of the left little finger, the cluster of highest activation was located in the SMA. Collectively, these data provide insight into orchestrated reorganization of the sensorimotor and temporal association cortices contributing to the skillful fingering and musical processing after the practice of playing stringed instruments.
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Affiliation(s)
- Dong‐Eog Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Min‐Jung Shin
- Interdisciplinary Program for Cognitive Sciences, Seoul National University, Seoul, South Korea
| | - Kyoung‐Min Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
- Interdisciplinary Program for Cognitive Sciences, Seoul National University, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung Ho Woo
- Interdisciplinary Program for Cognitive Sciences, Seoul National University, Seoul, South Korea
| | - Young Ro Kim
- Department of Radiology, NMR Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eun‐Cheol Song
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jun‐Won Lee
- Department of Neurology, Kwandong University College of Medicine, Kangneung, South Korea
| | - Seong‐Ho Park
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae‐Kyu Roh
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
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De Gennaro L, Cristiani R, Bertini M, Curcio G, Ferrara M, Fratello F, Romei V, Rossini PM. Handedness is mainly associated with an asymmetry of corticospinal excitability and not of transcallosal inhibition. Clin Neurophysiol 2004; 115:1305-12. [PMID: 15134697 DOI: 10.1016/j.clinph.2004.01.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2004] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The study aims to compare transcallosal inhibition (TI), as assessed by the paired-pulse transcranial magnetic stimulation (TMS) technique, in a sample of right-handed subjects (RH) and left-handed subjects (LH). Motor thresholds (MTs) and motor evoked potential (MEP) amplitudes were also measured in the two groups, as an index of corticospinal activity. METHODS Thirty-two normal subjects (16 RH and 16 LH) were recorded with a paired-pulse TMS paradigm (intensity of both pulses=120% of MT). The inter-stimulus intervals (ISIs) were 2, 4, 6, 8, 10, 12, 14, 16, 18, and 20 ms for both motor cortices, and MEP responses were recorded from the abductor digiti minimi muscles. RESULTS Both groups showed a clear TI centred around the 12 ms ISI, but no difference was found as a function of handedness or of hemisphere. On the other hand, the two groups differed in terms of corticospinal activity, since the hand motor dominant hemisphere had lower MTs than the non-dominant one in LH, and larger MEP amplitudes for the right hand were found in RH. CONCLUSIONS Results point to a functional asymmetry of the motor cortex on the hand-dominant versus the non-dominant hemisphere, while handedness does not seem associated with functional differences in callosal inhibition, as measured by the inter-hemispheric paired-pulse TMS technique.
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Affiliation(s)
- Luigi De Gennaro
- Dipartimento di Psicologia, Università di Roma La Sapienza, Via dei Marsi 78, 00185 Rome, Italy.
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