Paired-pulse navigated TMS is more effective than single-pulse navigated TMS for mapping upper extremity muscles in brain tumor patients期刊界 All Journals 搜尽天下杂志传播学术成果专业期刊搜索期刊信息化学术搜索

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Paired-pulse navigated TMS is more effective than single-pulse navigated TMS for mapping upper extremity muscles in brain tumor patients

Institution:	1. Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany;2. TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany;3. Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany;4. Department of Clinical Neurophysiology, Kuopio University Hospital, POB 100, 70029 KYS, Kuopio, Finland;5. A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland;6. Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland;7. Department of Applied Physics, University of Eastern Finland, Kuopio, Finland

Abstract:	ObjectiveSingle-pulse navigated transcranial magnetic stimulation (sp-nTMS) is used for presurgical motor mapping in patients with motor-eloquent lesions. However, recently introduced paired-pulse nTMS (pp-nTMS) with biphasic pulses could improve motor mapping.MethodsThirty-four patients (mean age: 56.0 ± 12.7 years, 53.0% high-grade glioma) with motor-eloquent lesions underwent motor mapping of upper extremity representations and nTMS-based tractography of the corticospinal tract (CST) by both sp-nTMS and pp-nTMS with biphasic pulses for the tumor-affected hemisphere before resection.ResultsIn three patients (8.8%), conventional sp-nTMS did not provide motor-positive points, in contrast to pp-nTMS that was capable of generating motor maps in all patients. Good concordance between pp-nTMS and sp-nTMS in the spatial location of motor hotspots and center of gravity (CoG) as well as for CST tracking was observed, with pp-nTMS leading to similar motor map volumes (585.0 ± 667.8 vs. 586.8 ± 204.2 mm³, p = 0.9889) with considerably lower resting motor thresholds (35.0 ± 8.8 vs. 32.8 ± 7.6% of stimulator output, p = 0.0004).ConclusionsPp-nTMS with biphasic pulses may provide motor maps even in highly demanding cases with tumor-affected motor structures or edema, using lower stimulation intensity compared to sp-nTMS.SignificancePp-nTMS with biphasic pulses could replace standardly used sp-nTMS for motor mapping and may be safer due to lower stimulation intensity.

Keywords:	Brain tumor Corticospinal excitability Motor cortex Navigated transcranial magnetic stimulation Paired-pulse stimulation 3D"} {"#name":"keyword" "$":{"id":"k0035"} "$$":[{"#name":"text" "_":"Three-dimensional AFNI"} {"#name":"keyword" "$":{"id":"k0045"} "$$":[{"#name":"text" "_":"Analysis of Functional NeuroImages ADM"} {"#name":"keyword" "$":{"id":"k0055"} "$$":[{"#name":"text" "_":"Abductor digiti minimi muscle APB"} {"#name":"keyword" "$":{"id":"k0065"} "$$":[{"#name":"text" "_":"Abductor pollicis brevis muscle BMRC"} {"#name":"keyword" "$":{"id":"k0075"} "$$":[{"#name":"text" "_":"British Medical Research Council CoG"} {"#name":"keyword" "$":{"id":"k0085"} "$$":[{"#name":"text" "_":"Center of gravity CSE"} {"#name":"keyword" "$":{"id":"k0095"} "$$":[{"#name":"text" "_":"Corticospinal excitability CST"} {"#name":"keyword" "$":{"id":"k0105"} "$$":[{"#name":"text" "_":"Corticospinal tract DES"} {"#name":"keyword" "$":{"id":"k0115"} "$$":[{"#name":"text" "_":"Direct electrical stimulation DTI"} {"#name":"keyword" "$":{"id":"k0125"} "$$":[{"#name":"text" "_":"Diffusion tensor imaging DTI FT"} {"#name":"keyword" "$":{"id":"k0135"} "$$":[{"#name":"text" "_":"Diffusion tensor imaging fiber tracking FA"} {"#name":"keyword" "$":{"id":"k0145"} "$$":[{"#name":"text" "_":"Fractional anisotropy FAT"} {"#name":"keyword" "$":{"id":"k0155"} "$$":[{"#name":"text" "_":"Fractional anisotropy threshold FLAIR"} {"#name":"keyword" "$":{"id":"k0165"} "$$":[{"#name":"text" "_":"Fluid attenuated inversion recovery MEP"} {"#name":"keyword" "$":{"id":"k0175"} "$$":[{"#name":"text" "_":"Motor-evoked potential MRI"} {"#name":"keyword" "$":{"id":"k0185"} "$$":[{"#name":"text" "_":"Magnetic resonance imaging nTMS"} {"#name":"keyword" "$":{"id":"k0195"} "$$":[{"#name":"text" "_":"Navigated transcranial magnetic stimulation pp-nTMS"} {"#name":"keyword" "$":{"id":"k0205"} "$$":[{"#name":"text" "_":"Paired-pulse nTMS rMT"} {"#name":"keyword" "$":{"id":"k0215"} "$$":[{"#name":"text" "_":"Resting motor threshold ROI"} {"#name":"keyword" "$":{"id":"k0225"} "$$":[{"#name":"text" "_":"Region of interest SD"} {"#name":"keyword" "$":{"id":"k0235"} "$$":[{"#name":"text" "_":"Standard deviation SICF"} {"#name":"keyword" "$":{"id":"k0245"} "$$":[{"#name":"text" "_":"Short-interval cortical facilitation sp-nTMS"} {"#name":"keyword" "$":{"id":"k0255"} "$$":[{"#name":"text" "_":"Single-pulse nTMS TR"} {"#name":"keyword" "$":{"id":"k0265"} "$$":[{"#name":"text" "_":"Tracking ratio uE"} {"#name":"keyword" "$":{"id":"k0275"} "$$":[{"#name":"text" "_":"Upper extremity VAS"} {"#name":"keyword" "$":{"id":"k0285"} "$$":[{"#name":"text" "_":"Visual analogue scale WHO"} {"#name":"keyword" "$":{"id":"k0295"} "$$":[{"#name":"text" "_":"World Health Organization
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