BACKGROUND: Navigated transcranial magnetic stimulation (nTMS) is increasingly used in presurgical brain mapping. Preoperative nTMS results correlate well with direct cortical stimulation (DCS) data in the identification of the primary motor cortex. Repetitive nTMS can also be used for mapping of speech-sensitive cortical areas. OBJECTIVE: The current cohort study compares the safety and effectiveness of preoperative nTMS with DCS mapping during awake surgery for the identification of language areas in patients with left-sided cerebral lesions. METHODS: Twenty patients with tumors in or close to left-sided language eloquent regions were examined by repetitive nTMS before surgery. During awake surgery, language-eloquent cortex was identified by DCS. nTMS results were compared for accuracy and reliability with regard to DCS by projecting both results into the cortical parcellation system. RESULTS: Presurgical nTMS maps showed an overall sensitivity of 90.2%, specificity of 23.8%, positive predictive value of 35.6%, and negative predictive value of 83.9% compared with DCS. For the anatomic Broca's area, the corresponding values were a sensitivity of 100%, specificity of 13.0%, positive predictive value of 56.5%, and negative predictive value of 100%, respectively. CONCLUSION: Good overall correlation between repetitive nTMS and DCS was observed, particularly with regard to negatively mapped regions. Noninvasive inhibition mapping with nTMS is evolving as a valuable tool for preoperative mapping of language areas. Yet its low specificity in posterior language areas in the current study necessitates further research to refine the methodology.

Navigated transcranial magnetic stimulation combined with electroencephalography (nTMS-EEG), allows noninvasive studies of cortical excitability and connectivity in humans. We investigated the reproducibility of nTMS-EEG in seven healthy subjects by repeating left motor and prefrontal cortical stimulation with a 1-week interval. TMS was applied at three intensities: 90, 100, and 110% of subjects' motor threshold (MT). The TMS-compatible neuronavigation system guaranteed precise repositioning of the stimulation coil. The responses were recorded by a 60-channel whole head TMS-compatible EEG amplifier. A high overall reproducibility (r > 0.80) was evident in nTMS-EEG responses over both hemispheres for both motor and prefrontal cortical stimulation. The results suggest that nTMS-EEG is a reliable tool for studies investigating cortical excitability changes in the test-retest designs.

At present, the expert panel recommends nTMS motor mapping in routine neurosurgical practice, as it has a sufficient level of evidence supporting its reliability. The panel recommends that nTMS language mapping be used in the framework of clinical studies to continue refinement of its protocol and increase reliability.

We present simultaneous Planck, Swift, Fermi, and ground-based data for 105 blazars belonging to three samples with flux limits in the soft X-ray, hard X-ray, and γ-ray bands, with additional 5 GHz flux-density limits to ensure a good probability of a Planck detection. We compare our results to those of a companion paper presenting simultaneous Planck and multi-frequency observations of 104 radio-loud northern active galactic nuclei selected at radio frequencies. While we confirm several previous results, our unique data set allows us to demonstrate that the selection method strongly influences the results, producing biases that cannot be ignored. Almost all the BL Lac objects have been detected by the Fermi Large Area Telescope (LAT), whereas 30% to 40% of the flat-spectrum radio quasars (FSRQs) in the radio, soft X-ray, and hard X-ray selected samples are still below the γ-ray detection limit even after integrating 27 months of Fermi-LAT data. The radio to sub-millimetre spectral slope of blazars is quite flat, with α ∼ 0 up to about 70 GHz, above which it steepens to α ∼ −0.65. The BL Lacs have significantly flatter spectra than FSRQs at higher frequencies. The distribution of the rest-frame synchrotron peak frequency (ν of BL Lacs are much broader and are shifted to higher energies than those of FSRQs; their shapes strongly depend on the selection method. The Compton dominance of blazars, defined as the ratio of the inverse Compton to synchrotron peak luminosities, ranges from less than 0.2 to nearly 100, with only FSRQs reaching values larger than about 3. Its distribution is broad and depends strongly on the selection method, with γ-ray selected blazars peaking at ∼7 or more, and radio-selected blazars at values close to 1, thus implying that the common assumption that the blazar power budget is largely dominated by high-energy emission is a selection effect. A comparison of our multi-frequency data with theoretical predictions shows that simple homogeneous SSC models cannot explain the simultaneous SEDs of most of the γ-ray detected blazars in all samples. The SED of the blazars that were not detected by Fermi-LAT may instead be consistent with SSC emission. Our data challenge the correlation between bolometric luminosity and ν S peak predicted by the blazar sequence.