Resection of Navigated Transcranial Magnetic Stimulation-Positive Prerolandic Motor Areas Causes Permanent Impairment of Motor Function

Moser, Tobias; Bulubas, Lucia; Sabih, Jamil; Conway, Neal; Wildschutz, Noémie; Sollmann, Nico; Meyer, Bernhard; Ringel, Florian; Krieg, Sandro M.

doi:10.1093/neuros/nyw169

Cited by 26 publications

(19 citation statements)

References 26 publications

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“…Indeed, the extent and exact spatial location of motor representations are not fixed and have shown to be subject to a high degree of plasticity and inter-individual differences in presence of brain tumors [49][50][51][52][53]. Further, previous work has shown that true motor-positive spots belonging to the primary motor representations can extent far anteriorly into the suspected supplementary motor areas [54]. Thus, more widespread patterns of motor-positive points as mapped out by pp-nTMS, reaching even beyond the borders of the precentral gyrus, seem possible and need to be considered for further validation.…”

Section: Discussionmentioning

confidence: 99%

Short-Interval Intracortical Facilitation Improves Efficacy in nTMS Motor Mapping of Lower Extremity Muscle Representations in Patients with Supra-Tentorial Brain Tumors

Zhang

Julkunen

Schröder

et al. 2020

Cancers

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Navigated transcranial magnetic stimulation (nTMS) is increasingly used for mapping of motor function prior to surgery in patients harboring motor-eloquent brain lesions. To date, single-pulse nTMS (sp-nTMS) has been predominantly used for this purpose, but novel paired-pulse nTMS (pp-nTMS) with biphasic pulse application has been made available recently. The purpose of this study was to systematically evaluate pp-nTMS with biphasic pulses in comparison to conventionally used sp-nTMS for preoperative motor mapping of lower extremity (lE) muscle representations. Thirty-nine patients (mean age: 56.3 ± 13.5 years, 69.2% males) harboring motor-eloquent brain lesions of different entity underwent motor mapping of lE muscle representations in lesion-affected hemispheres and nTMS-based tractography of the corticospinal tract (CST) using data from sp-nTMS and pp-nTMS with biphasic pulses, respectively. Compared to sp-nTMS, pp-nTMS enabled motor mapping with lower stimulation intensities (61.8 ± 13.8% versus 50.7 ± 11.6% of maximum stimulator output, p < 0.0001), and it provided reliable motor maps even in the most demanding cases where sp-nTMS failed (pp-nTMS was able to provide a motor map in five patients in whom sp-nTMS did not provide any motor-positive points, and pp-nTMS was the only modality to provide a motor map in one patient who also did not show motor-positive points during intraoperative stimulation). Fiber volumes of the tracked CST were slightly higher when motor maps of pp-nTMS were used, and CST tracking using pp-nTMS data was also possible in the five patients in whom sp-nTMS failed. In conclusion, application of pp-nTMS with biphasic pulses enables preoperative motor mapping of lE muscle representations even in the most challenging patients in whom the motor system is at high risk due to lesion location or resection.

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Section: Discussionmentioning

confidence: 99%

Short-Interval Intracortical Facilitation Improves Efficacy in nTMS Motor Mapping of Lower Extremity Muscle Representations in Patients with Supra-Tentorial Brain Tumors

Zhang

Julkunen

Schröder

et al. 2020

Cancers

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“…This was done to ensure that induced motor impairment during SMA mapping could be attributed to SMA stimulation without being confounded by possible stimulation of very anterior parts of primary motor cortex representations 36,65,66 . Prior reports have indicated that the primary motor cortex can extend far anteriorly and beyond the precentral gyrus, with resection of very anterior motor-positive stimulation spots causing postoperative motor deficits related to the primary motor cortex 65 . The number of targets was chosen to allow for complete extension over the anatomical region corresponding to the SMA, while at the same time remaining far enough apart to allow for allocation of effects to each specific target (without presumed stimulation overlap).…”

Section: Methodsmentioning

confidence: 99%

Navigated transcranial magnetic stimulation of the supplementary motor cortex disrupts fine motor skills in healthy adults

Schramm

Albers

Ille

et al. 2019

Sci Rep

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Navigated transcranial magnetic stimulation (nTMS) over the supplementary motor area (SMA) may impact fine motor skills. This study evaluates different nTMS parameters in their capacity to affect fine motor performance on the way to develop an SMA mapping protocol. Twenty healthy volunteers performed a variety of fine motor tests during baseline and nTMS to the SMA using 5 Hz, 10 Hz, and theta-burst stimulation (TBS). Effects on performance were measured by test completion times (TCTs), standard deviation of inter-tap interval (SDIT), and visible coordination problems (VCPs). The predominant stimulation effect was slowing of TCTs, i.e. a slowdown of test performances during stimulation. Furthermore, participants exhibited VCPs like accidental use of contralateral limbs or inability to coordinate movements. More instances of significant differences between baseline and stimulation occurred during stimulation of the right hemisphere compared to left-hemispheric stimulation. In conclusion, nTMS to the SMA could enable new approaches in neuroscience and enable structured mapping approaches. Specifically, this study supports interhemispheric differences in motor control as right-hemispheric stimulation resulted in clearer impairments. The application of our nTMS-based setup to assess the function of the SMA should be applied in patients with changed anatomo-functional representations as the next step, e.g. among patients with eloquent brain tumors.

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“…This could occur due to the fact that currents perpendicular to the sulcal wall of the precentral gyrus more strongly activate pyramidal neurons in the cortical sheet as compared to currents flowing parallel to the sulcal wall [28]. Studies investigating direct cortical stimulation (DCS) and navigated TMS have shown that stimulation of the premotor cortex can indeed induce motor activity [11] [29]. Unfortunately, both studies only used a PAinduced current direction during TMS motor mapping, which precluded a comparison with LM-induced current.…”

Section: Pa-and Lm-induced Currents Identify Different Mep Motor Mapsmentioning

confidence: 99%

“…In this way, TMS has been shown to be able to identify significantly separated motor area centers for different muscles in the upper extremity [4]. Neuronavigated TMS (nTMS) can potentially be of value in the preparation of neurosurgical interventions in the vicinity of the primary motor cortex, or to monitor changes in the primary motor cortex during the course of rehabilitation (of motor function) after stroke [5]- [11].…”

Section: Introductionmentioning

confidence: 99%

Outcome of TMS-based motor mapping depends on TMS current direction

Mandija

et al. 2018

Preprint

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Navigated transcranial magnetic stimulation (TMS) in combination with electromyography (EMG) recordings can be used to map the brain regions in which TMS evokes motor-evoked potentials (MEPs) in certain muscles. Navigated TMS (nTMS) is used increasingly to identify the functional motor area of different muscles for clinical applications, including neurosurgical planning. However, the accuracy of TMS-based mapping of functional motor areas may depend on the TMS-induced current direction due to anisotropic cortical morphology, complicating association of the functional motor maps with neuroanatomical structures. Furthermore, it is not clear how well nTMS can distinguish nearby muscle representations on the cortical surface. We therefore investigated the functional motor maps obtained with posterior-to-anterior (PA) and lateral-to-medial (LM) TMS-induced currents within a spatially defined area by stimulating targets in a grid of locations over the left primary motor cortex in 8 healthy participants. Results were compared to functional MRI (fMRI) activation maps obtained using a voluntary opposing thumb movement task. We found that TMS applied with PA-induced currents identifies a motor area that is located significantly more anterior (8.7 -10.4 mm depending on the muscle) with respect to an MEP motor area identified using LM-induced currents for the same muscle. Motor maps obtained with LM-induced currents show more overlap with the motor map identified using fMRI compared to PA-induced currents. In conclusion, the spatial representation of the MEP motor map identified by TMS is dependent on the direction of the induced current. These findings suggest that the application of nTMS using an LM-induced current direction corresponds best with the hand motor area as measured with fMRI.

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Resection of Navigated Transcranial Magnetic Stimulation-Positive Prerolandic Motor Areas Causes Permanent Impairment of Motor Function

Abstract: After resection of nTMS-positive motor points, 62% of patients suffered from a new permanent paresis. Thus, even though they are located in the superior or middle frontal gyrus, these cortical areas must undergo intraoperative mapping.

Cited by 26 publications

References 26 publications

Short-Interval Intracortical Facilitation Improves Efficacy in nTMS Motor Mapping of Lower Extremity Muscle Representations in Patients with Supra-Tentorial Brain Tumors

Short-Interval Intracortical Facilitation Improves Efficacy in nTMS Motor Mapping of Lower Extremity Muscle Representations in Patients with Supra-Tentorial Brain Tumors

Navigated transcranial magnetic stimulation of the supplementary motor cortex disrupts fine motor skills in healthy adults

Outcome of TMS-based motor mapping depends on TMS current direction

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