Protocol for mapping of the supplementary motor area using repetitive navigated transcranial magnetic stimulation

Engelhardt, Melina; Kern, Giulia; Karhu, Jari; Picht, Thomas

doi:10.3389/fnins.2023.1185483

Cited by 3 publications

(8 citation statements)

References 25 publications

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“…Following the virtual lesion paradigm, the current results are in line with previous studies showing that rnTMS applied to the SMA can induce a reduction of finger taps ( Schramm et al, 2019 ; Engelhardt et al, 2023 ). Mapping of both hemispheres was possible similarly to preceding studies which used the Jebsen-Taylor hand function test ( Schramm et al, 2019 , 2020 ).…”

Section: Discussionsupporting

confidence: 91%

“…The current study refined and standardised the protocol description and error classification of the previously proposed protocol ( Engelhardt et al, 2023 ). According to this new protocol a minimum of 15 points was stimulated twice per hemisphere and subject.…”

Section: Discussionmentioning

confidence: 99%

“…Starting with the upper extremity the SMA was mapped using repetitive nTMS (20 Hz, 120% RMT, 5 s bursts, ITI 5 s) with the stimulation coil positioned perpendicular to the interhemispheric cleft ( Engelhardt et al, 2023 ). Subjects were instructed to perform a finger tapping task for 5 s by tapping the index finger as fast as possible ( Hiroshima et al, 2014 ; Schramm et al, 2019 ; Engelhardt et al, 2023 ). The number of taps was recorded by the Apple iPad App Counter +.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, a protocol for mapping of the SMA with a higher spatial resolution compared to fMRI using repetitive nTMS (rnTMS) has been proposed. This protocol used a finger tapping task to localise upper extremity motor function in the SMA of the dominant hemisphere in healthy subjects ( Engelhardt et al, 2023 ).…”

Section: Introductionmentioning

confidence: 99%

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Mapping of the supplementary motor area using repetitive navigated transcranial magnetic stimulation

Kern,

Kempter,

Picht

et al. 2023

Front. Neurosci.

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BackgroundThe supplementary motor area (SMA) is important for motor and language function. Damage to the SMA may harm these functions, yet tools for a preoperative assessment of the area are still sparse.ObjectiveThe aim of this study was to validate a mapping protocol using repetitive navigated transcranial magnetic stimulation (rnTMS) and extend this protocol for both hemispheres and lower extremities.MethodsTo this purpose, the SMA of both hemispheres were mapped based on a finger tapping task for 30 healthy subjects (35.97 ± 15.11, range 21–67 years; 14 females) using rnTMS at 20 Hz (120% resting motor threshold (RMT)) while controlling for primary motor cortex activation. Points with induced errors were marked on the corresponding MRI. Next, on the identified SMA hotspot a bimanual finger tapping task and the Nine-Hole Peg Test (NHPT) were performed. Further, the lower extremity was mapped at 20 Hz (140%RMT) using a toe tapping task.ResultsMean finger tapping scores decreased significantly during stimulation (25.70taps) compared to baseline (30.48; p < 0.01). Bimanual finger tapping led to a significant increase in taps during stimulation (28.43taps) compared to unimanual tapping (p < 0.01). Compared to baseline, completion time for the NHPT increased significantly during stimulation (baseline: 13.6 s, stimulation: 16.4 s; p < 0.01). No differences between hemispheres were observed.ConclusionThe current study validated and extended a rnTMS based protocol for the mapping of the SMA regarding motor function of upper and lower extremity. This protocol could be beneficial to better understand functional SMA organisation and improve preoperative planning in patients with SMA lesions.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mapping of the supplementary motor area using repetitive navigated transcranial magnetic stimulation

Kern,

Kempter,

Picht

et al. 2023

Front. Neurosci.

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“…In 2023, Engelhardt et al provided a protocol for mapping the SMA via nTMS [ 30 ]. nTMS stimulation of the SMA led to a significant reduction of finger taps compared to the baseline (p-value 0.01).…”

Section: Discussionmentioning

confidence: 99%

Permanent deterioration of fine motor skills after the resection of tumors in the supplementary motor area

Maurer,

Butenschoen,

Kelm

et al. 2024

Neurosurg Rev

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Supplementary motor area syndrome (SMAS) represents a common neurosurgical sequela. The incidence and time frame of its occurrence have yet to be characterized after surgery for brain tumors. We examined patients suffering from a brain tumor preoperatively, postoperatively, and during follow-up examinations after three months, including fine motor skills testing and transcranial magnetic stimulation (TMS). 13 patients suffering from a tumor in the dorsal part of the superior frontal gyrus underwent preoperative, early postoperative, and 3-month follow-up testing of fine motor skills using the Jebsen-Taylor Hand Function Test (JHFT) and the Nine-Hole Peg Test (NHPT) consisting of 8 subtests for both upper extremities. They completed TMS for cortical motor function mapping. Test completion times (TCTs) were recorded and compared. No patient suffered from neurological deficits before surgery. On postoperative day one, we detected motor deficits in two patients, which remained clinically stable at a 3-month follow-up. Except for page-turning, every subtest indicated a significant worsening of function, reflected by longer TCTs (p < 0.05) in the postoperative examinations for the contralateral upper extremity (contralateral to the tumor manifestation). At 3-month follow-up examinations for the contralateral upper extremity, each subtest indicated significant worsening compared to the preoperative status despite improvement to the immediate postoperative level. We also detected significantly longer TCTs (p < 0.05) postoperatively in the ipsilateral upper extremity. This study suggests a long-term worsening of fine motor skills even three months after SMA tumor resection, indicating the necessity of targeted physical therapy for these patients.

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Stimulation of the Frontal Aslant Tract’s origin in the caudal superior frontal gyrus alters ongoing spontaneous rhythmic activity independently from the effector. Evidence from tractography-guided Transcranial Magnetic Stimulation

Tagliaferri,

Glaubig,

DiChiaro

et al. 2024

Preprint

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The crown of the human Superior Frontal Gyrus (SFG-crown) is a functionally independent region, nestled between the dorsal premotor and supplementary motor cortices, that supports internally-timed action control. The unique SFG-crown's connectivity fingerprint by the Frontal Aslant Tract (FAT), suggests a caudal-rostral pattern of increasing abstractness of action representations. Coherently, since the mid-portion of the caudal SFG contains a representation of action strategies that involve internal timing, we hypothesized that the caudal portion of the SFG may be involved in action execution of internally-timed actions. To test this, we asked 21 healthy participants to perform a self-paced tapping movement with the right index finger or a self-paced articulation of the syllable /da/ while applying online single-pulse TMS to the posterior, middle and anterior origins of the FAT in the left SFG-crown. Results showed that effective TMS (compared to sham) impacted rhythm production in both tasks, only when applied to the posterior SFG region, by reducing the probability of motor events in the 200 ms following TMS. The present data support the hypothesis, that the posterior SFG-crown, associated with the most posterior origin of the FAT fibers, is involved in the production of internally-timed actions, in an effector-independent modality, suggesting a domain-general role in the execution of internally-timed movements.

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Protocol for mapping of the supplementary motor area using repetitive navigated transcranial magnetic stimulation

Cited by 3 publications

References 25 publications

Mapping of the supplementary motor area using repetitive navigated transcranial magnetic stimulation

Mapping of the supplementary motor area using repetitive navigated transcranial magnetic stimulation

Permanent deterioration of fine motor skills after the resection of tumors in the supplementary motor area

Stimulation of the Frontal Aslant Tract’s origin in the caudal superior frontal gyrus alters ongoing spontaneous rhythmic activity independently from the effector. Evidence from tractography-guided Transcranial Magnetic Stimulation

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