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Matsuda RH, Souza VH, Marchetti TC, Soto AM, Kahilakoski OP, Zhdanov A, Malheiro VHE, Laine M, Nyrhinen M, Sinisalo H, Kicic D, Lioumis P, Ilmoniemi RJ, Baffa O. Robotic-electronic platform for autonomous and accurate transcranial magnetic stimulation targeting. Brain Stimul 2024; 17:469-472. [PMID: 38582491 DOI: 10.1016/j.brs.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/15/2024] [Accepted: 03/31/2024] [Indexed: 04/08/2024] Open
Affiliation(s)
- Renan H Matsuda
- Department of Physics, Faculty of Philosophy Sciences and Letters of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, 14040-901, Ribeirão Preto, SP, Brazil; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Rakentajanaukio 2, 02150, Espoo, Finland.
| | - Victor H Souza
- Department of Physics, Faculty of Philosophy Sciences and Letters of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, 14040-901, Ribeirão Preto, SP, Brazil; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Rakentajanaukio 2, 02150, Espoo, Finland; School of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Thais C Marchetti
- Department of Physics, Faculty of Philosophy Sciences and Letters of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, 14040-901, Ribeirão Preto, SP, Brazil
| | - Ana M Soto
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Rakentajanaukio 2, 02150, Espoo, Finland
| | - Olli-Pekka Kahilakoski
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Rakentajanaukio 2, 02150, Espoo, Finland
| | - Andrey Zhdanov
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Rakentajanaukio 2, 02150, Espoo, Finland
| | - Victor H E Malheiro
- Department of Physics, Faculty of Philosophy Sciences and Letters of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, 14040-901, Ribeirão Preto, SP, Brazil
| | - Mikael Laine
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Rakentajanaukio 2, 02150, Espoo, Finland
| | - Mikko Nyrhinen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Rakentajanaukio 2, 02150, Espoo, Finland
| | - Heikki Sinisalo
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Rakentajanaukio 2, 02150, Espoo, Finland
| | - Dubravko Kicic
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Rakentajanaukio 2, 02150, Espoo, Finland
| | - Pantelis Lioumis
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Rakentajanaukio 2, 02150, Espoo, Finland
| | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Rakentajanaukio 2, 02150, Espoo, Finland
| | - Oswaldo Baffa
- Department of Physics, Faculty of Philosophy Sciences and Letters of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, 14040-901, Ribeirão Preto, SP, Brazil
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Selective Stimulus Intensity during Hotspot Search Ensures Faster and More Accurate Preoperative Motor Mapping with nTMS. Brain Sci 2023; 13:brainsci13020285. [PMID: 36831828 PMCID: PMC9954713 DOI: 10.3390/brainsci13020285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Navigated transcranial magnetic stimulation (nTMS) has emerged as one of the most innovative techniques in neurosurgical practice. However, nTMS motor mapping involves rigorous steps, and the importance of an accurate execution method has not been emphasized enough. In particular, despite strict adherence to procedural protocols, we have observed high variability in map activation according to the choice of stimulation intensity (SI) right from the early stage of hotspot localization. We present a retrospective analysis of motor mappings performed between March 2020 and July 2022, where the SI was only chosen with rigorous care in the most recent ones, under the guide of an expert neurophysiologist. MATERIALS AND METHODS In order to test the ability to reduce inaccurate responses and time expenditure using selective SI, data were collected from 16 patients who underwent mapping with the random method (group A) and 15 patients who underwent mapping with the proposed method (group B). The parameters considered were resting motor threshold (%), number of stimuli, number of valid motor evoked potentials (MEPs), number of valid MEPs considered true positives (TPs), number of valid MEPs considered false positives (FPs), ratio of true-positive MEPs to total stimuli, ratio of true-positive MEPs to valid MEPs, minimum amplitude, maximum amplitude and mapping time for each patient. RESULTS The analysis showed statistically significant reductions in total stimulus demand, procedural time and number of false-positive MEPs. Significant increases were observed in the number of true-positive MEPs, the ratio of true-positive MEPs to total stimuli and the ratio of true-positive MEPs to valid MEPs. In the subgroups analyzed, there were similar trends, in particular, an increase in true positives and a decrease in false-positive responses. CONCLUSIONS The precise selection of SI during hotspot search in nTMS motor mapping could provide reliable cortical maps in short time and with low employment of resources. This method seems to ensure that a MEP really represents a functionally eloquent cortical point, making mapping more intuitive even in less experienced centers.
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Devices and Technology in Transcranial Magnetic Stimulation: A Systematic Review. Brain Sci 2022; 12:brainsci12091218. [PMID: 36138954 PMCID: PMC9496961 DOI: 10.3390/brainsci12091218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 01/18/2023] Open
Abstract
The technology for transcranial magnetic stimulation (TMS) has significantly changed over the years, with important improvements in the signal generators, the coils, the positioning systems, and the software for modeling, optimization, and therapy planning. In this systematic literature review (SLR), the evolution of each component of TMS technology is presented and analyzed to assess the limitations to overcome. This SLR was carried out following the PRISMA 2020 statement. Published articles of TMS were searched for in four databases (Web of Science, PubMed, Scopus, IEEE). Conference papers and other reviews were excluded. Records were filtered using terms about TMS technology with a semi-automatic software; articles that did not present new technology developments were excluded manually. After this screening, 101 records were included, with 19 articles proposing new stimulator designs (18.8%), 46 presenting or adapting coils (45.5%), 18 proposing systems for coil placement (17.8%), and 43 implementing algorithms for coil optimization (42.6%). The articles were blindly classified by the authors to reduce the risk of bias. However, our results could have been influenced by our research interests, which would affect conclusions for applications in psychiatric and neurological diseases. Our analysis indicates that more emphasis should be placed on optimizing the current technology with a special focus on the experimental validation of models. With this review, we expect to establish the base for future TMS technological developments.
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Sorkhabi MM, Denison T. A neurostimulator system for real, sham, and multi-target transcranial magnetic stimulation. J Neural Eng 2022; 19:10.1088/1741-2552/ac60c9. [PMID: 35325879 PMCID: PMC7614713 DOI: 10.1088/1741-2552/ac60c9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/24/2022] [Indexed: 11/11/2022]
Abstract
Objective.Transcranial magnetic stimulation (TMS) is a clinically effective therapeutic instrument used to modulate neural activity. Despite three decades of research, two challenging issues remain, the possibility of changing the (a) stimulated spot and (b) stimulation type (real or sham) without physically moving the coil. In this study, a second-generation programmable TMS device with advanced stimulus shaping is introduced that uses a five-level cascaded H-bridge inverter and phase-shifted pulse-width modulation. The principal idea of this research is to obtain real, sham, and multi-locus stimulation using the same TMS system.Approach.We propose a two-channel modulation-based magnetic pulse generator and a novel coil arrangement, consisting of two circular coils with a physical distance of 20 mm between the coils and a control method for modifying the effective stimulus intensity, which leads to the live steerability of the target and type of stimulation.Main results.Based on the measured system performance, the stimulation profile can be steered ±20 mm along a line from the centroid of the coil locations by modifying the modulation index.Significance.The proposed system supports electronic control of the stimulation spot without physical coil movement, resulting in tunable modulation of targets, which is a crucial step towards automated TMS machines.
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Affiliation(s)
- Majid Memarian Sorkhabi
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX1 3TH, UK
| | - Timothy Denison
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX1 3TH, UK
- Department of Engineering Science, University of Oxford, Oxford, OX1 3PJ, UK
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Schiavao LJV, Neville Ribeiro I, Yukie Hayashi C, Gadelha Figueiredo E, Russowsky Brunoni A, Jacobsen Teixeira M, Pokorny G, Silva Paiva W. Assessing the Capabilities of Transcranial Magnetic Stimulation (TMS) to Aid in the Removal of Brain Tumors Affecting the Motor Cortex: A Systematic Review. Neuropsychiatr Dis Treat 2022; 18:1219-1235. [PMID: 35734549 PMCID: PMC9208734 DOI: 10.2147/ndt.s359855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The brain tumor is frequently related to severe motor impairment and impacts the quality of life. The corticospinal tract can sometimes be affected depending on the type and size of the neoplasm, so different tools can evaluate motor function and connections. It is essential to organize surgical procedures and plan the approach. Functional motor status is mapped before, during, and after surgery. Studying corticospinal tract status can help map the functional areas, predict postoperative outcomes, and help the decision, reducing neurological deficits, aiming to preserve functional networks, using the concepts of white matters localization and fibbers connections. Nowadays, there are new techniques that provide functional information regarding the motor cortex, such as transcranial magnetic stimulation (TMS), direct cortical stimulation (DCS), and navigated TMS (nTMS). These tools can be used to plan a customized surgical strategy and the role of motor evoked potentials (MEPs) is well described during intra-operative, using intraoperative neuromonitoring. MEPs can help to localize primary motor areas and delineate the cut-off point of resection in real-time, using direct stimulation. In the post-operative, the MEP has increased your function as a predictive marker of permanent or transitory neurological lesion marker. METHODS Systematic review performed in MEDLINE via PUBMED, EMBASE, and SCOPUS databases regarding the post-operative assessment of MEP in patients with brain tumors. The search strategy included the following terms: (("Evoked Potentials, Motor"[Mesh]) AND "Neoplasms"[Mesh]) AND "Transcranial Magnetic Stimulation"[Mesh] AND "Brain Tumor"[Mesh]), the analysis followed the PRISMA guidelines for systematic reviews, the review spanned until 06/04/2021, inclusion criteria were studies presenting confirmed diagnosis of brain tumor (primary or metastatic), patients >18 y/o, using TMS, Navigated TMS, and/or Evoked Potentials as tools in preoperative planning or at the intra-operative helping the evaluation of the neurological status of the motor cortex, articles published in peer-reviewed journals, and written in English or Portuguese. RESULTS A total of 38 studies were selected for this review, of which 14 investigated the potential of nTMS to predict the occurrence of motor deficits, while 25 of the articles investigated the capabilities of the nTMS technique in performing pre/intraoperative neuro mapping of the motor cortex. CONCLUSION Further studies regarding motor function assessment are needed and standardized protocols for MEPs also need to be defined.
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Affiliation(s)
- Lucas Jose Vaz Schiavao
- Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo- FMUSP - University of São Paulo, São Paulo, Brazil.,Neurology, Instituto do Câncer do Estado de São Paulo - ICESP, São Paulo, Brazil
| | - Iuri Neville Ribeiro
- Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo- FMUSP - University of São Paulo, São Paulo, Brazil.,Neurology, Instituto do Câncer do Estado de São Paulo - ICESP, São Paulo, Brazil
| | - Cintya Yukie Hayashi
- Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo- FMUSP - University of São Paulo, São Paulo, Brazil
| | - Eberval Gadelha Figueiredo
- Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo- FMUSP - University of São Paulo, São Paulo, Brazil
| | - Andre Russowsky Brunoni
- Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo- FMUSP - University of São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo- FMUSP - University of São Paulo, São Paulo, Brazil
| | | | - Wellingson Silva Paiva
- Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo- FMUSP - University of São Paulo, São Paulo, Brazil
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Batschelett M, Gibbs S, Holder CM, Holcombe B, Wheless JW, Narayana S. Plasticity in the developing brain: neurophysiological basis for lesion-induced motor reorganization. Brain Commun 2021; 4:fcab300. [PMID: 35174326 PMCID: PMC8842689 DOI: 10.1093/braincomms/fcab300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/10/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
The plasticity of the developing brain can be observed following injury to the
motor cortex and/or corticospinal tracts, the most commonly injured brain area
in the pre- or peri-natal period. Factors such as the timing of injury, lesion
size and lesion location may affect a single hemisphere’s ability to
acquire bilateral motor representation. Bilateral motor representation of single
hemisphere origin is most likely to occur if brain injury occurs before the age
of 2 years; however, the link between injury aetiology, reorganization type and
functional outcome is largely understudied. We performed a retrospective review
to examine reorganized cortical motor maps identified through transcranial
magnetic stimulation in a cohort of 52 patients. Subsequent clinical,
anthropometric and demographic information was recorded for each patient. Each
patient’s primary hand motor cortex centre of gravity, along with the
Euclidian distance between reorganized and normally located motor cortices, was
also calculated. The patients were classified into broad groups including
reorganization type (inter- and intrahemispheric motor reorganization), age at
the time of injury (before 2 years and after 2 years) and injury aetiology
(developmental disorders and acquired injuries). All measures were analysed to
find commonalities between motor reorganization type and injury aetiology,
function and centre of gravity distance. There was a significant effect of
injury aetiology on type of motor reorganization
(P < 0.01), with 60.7% of patients
with acquired injuries and 15.8% of patients with developmental disorders
demonstrating interhemispheric motor reorganization. Within the interhemispheric
motor reorganization group, ipsilaterally and contralaterally projecting hand
motor cortex centres of gravity overlapped, indicating shared cortical motor
representation. Furthermore, the data suggest significantly higher prevalence of
bilateral motor representation from a single hemisphere in cases of acquired
injuries compared to those of developmental origin. Functional outcome was found
to be negatively affected by acquired injuries and interhemispheric motor
reorganization relative to their respective counterparts with developmental
lesions and intrahemispheric motor reorganization. These results provide novel
information regarding motor reorganization in the developing brain via an
unprecedented cohort sample size and transcranial magnetic stimulation.
Transcranial magnetic stimulation is uniquely suited for use in understanding
the principles of motor reorganization, thereby aiding in the development of
more efficacious therapeutic techniques to improve functional recovery following
motor cortex injury.
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Affiliation(s)
- Mitchell Batschelett
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN, USA
- Rhodes College, Memphis, TN, USA
| | - Savannah Gibbs
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN, USA
| | - Christen M. Holder
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN, USA
- Department of Pediatrics, Division of Pediatric Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Billy Holcombe
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN, USA
- Department of Pediatrics, Division of Pediatric Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James W. Wheless
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN, USA
- Department of Pediatrics, Division of Pediatric Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Shalini Narayana
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN, USA
- Department of Pediatrics, Division of Pediatric Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Anatomy and Neurobiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Sondergaard RE, Martino D, Kiss ZHT, Condliffe EG. TMS Motor Mapping Methodology and Reliability: A Structured Review. Front Neurosci 2021; 15:709368. [PMID: 34489629 PMCID: PMC8417420 DOI: 10.3389/fnins.2021.709368] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022] Open
Abstract
Motor cortical representation can be probed non-invasively using a transcranial magnetic stimulation (TMS) technique known as motor mapping. The mapping technique can influence features of the maps because of several controllable elements. Here we review the literature on six key motor mapping parameters, as well as their influence on outcome measures and discuss factors impacting their selection. 132 of 1,587 distinct records were examined in detail and synthesized to form the basis of our review. A summary of mapping parameters, their impact on outcome measures and feasibility considerations are reported to support the design and interpretation of TMS mapping studies.
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Affiliation(s)
- Rachel E. Sondergaard
- Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Davide Martino
- Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Zelma H. T. Kiss
- Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Elizabeth G. Condliffe
- Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
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Noccaro A, Mioli A, D'Alonzo M, Pinardi M, Pino GD, Formica D. Development and Validation of a Novel Calibration Methodology and Control Approach for Robot-Aided Transcranial Magnetic Stimulation (TMS). IEEE Trans Biomed Eng 2021; 68:1589-1600. [PMID: 33513096 DOI: 10.1109/tbme.2021.3055434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This article presents the development and validation of a new robotic system for Transcranial Magnetic Stimulation (TMS), characterized by a new control approach, and an ad-hoc calibration methodology, specifically devised for the TMS application. METHODS The robotic TMS platform is composed of a 7 dof manipulator, controlled by an impedance control, and a camera-based neuronavigation system. The proposed calibration method was optimized on the workspace useful for the specific TMS application (spherical shell around the subject's head), and tested on three different hand-eye and robot-world calibration algorithms. The platform functionality was tested on six healthy subjects during a real TMS procedure, over the left primary motor cortex. RESULTS employing our method significantly decreases ( ) the calibration error by 34% for the position and 19% for the orientation. The robotic TMS platform achieved greater orientation accuracy than the expert operators, significantly reducing orientation errors by 46% ( ). No significant differences were found in the position errors and in the amplitude of the motor evoked potentials (MEPs) between the robot-aided TMS and the expert operators. CONCLUSION The proposed calibration represents a valid method to significantly reduce the calibration errors in robot-aided TMS applications. Results showed the efficacy of the proposed platform (including the control algorithm) in administering a real TMS procedure, achieving better coil positioning than expert operators, and similar results in terms of MEPs. SIGNIFICANCE This article spotlights how to improve the performance of a robotic TMS platform, providing a reproducible and low-cost alternative to the few devices commercially available.
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Roos D, Biermann L, Jarczok TA, Bender S. Local Differences in Cortical Excitability - A Systematic Mapping Study of the TMS-Evoked N100 Component. Front Neurosci 2021; 15:623692. [PMID: 33732105 PMCID: PMC7959732 DOI: 10.3389/fnins.2021.623692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) with simultaneous electroencephalography applied to the primary motor cortex provides two parameters for cortical excitability: motor evoked potentials (MEPs) and TMS-evoked potentials (TEPs). This study aimed to evaluate the effects of systematic coil shifts on both the TEP N100 component and MEPs in addition to the relationship between both parameters. In 12 healthy adults, the center of a standardized grid was fixed above the hot spot of the target muscle of the left primary motor cortex. Twelve additional positions were arranged in a quadratic grid with positions between 5 and 10 mm from the hot spot. At each of the 13 positions, TMS single pulses were applied. The topographical maximum of the resulting N100 was located ipsilateral and slightly posterior to the stimulation site. A source analysis revealed an equivalent dipole localized more deeply than standard motor cortex coordinates that could not be explained by a single seeded primary motor cortex dipole. The N100 topography might not only reflect primary motor cortex activation, but also sum activation of the surrounding cortex. N100 amplitude and latency decreased significantly during stimulation anterior-medial to the hot spot although MEP amplitudes were smaller at all other stimulation sites. Therefore, N100 amplitudes might be suitable for detecting differences in local cortical excitability. The N100 topography, with its maximum located posterior to the stimulation site, possibly depends on both anatomical characteristics of the stimulated cortex and differences in local excitability of surrounding cortical areas. The less excitable anterior cortex might contribute to a more posterior maximum. There was no correlation between N100 and MEP amplitudes, but a single-trial analysis revealed a trend toward larger N100 amplitudes in trials with larger MEPs. Thus, functionally efficient cortical excitation might increase the probability of higher N100 amplitudes, but TEPs are also generated in the absence of MEPs.
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Affiliation(s)
- Daniela Roos
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lea Biermann
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tomasz A Jarczok
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Bender
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Rossi S, Antal A, Bestmann S, Bikson M, Brewer C, Brockmöller J, Carpenter LL, Cincotta M, Chen R, Daskalakis JD, Di Lazzaro V, Fox MD, George MS, Gilbert D, Kimiskidis VK, Koch G, Ilmoniemi RJ, Lefaucheur JP, Leocani L, Lisanby SH, Miniussi C, Padberg F, Pascual-Leone A, Paulus W, Peterchev AV, Quartarone A, Rotenberg A, Rothwell J, Rossini PM, Santarnecchi E, Shafi MM, Siebner HR, Ugawa Y, Wassermann EM, Zangen A, Ziemann U, Hallett M. Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Clin Neurophysiol 2021; 132:269-306. [PMID: 33243615 PMCID: PMC9094636 DOI: 10.1016/j.clinph.2020.10.003] [Citation(s) in RCA: 524] [Impact Index Per Article: 174.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/11/2022]
Abstract
This article is based on a consensus conference, promoted and supported by the International Federation of Clinical Neurophysiology (IFCN), which took place in Siena (Italy) in October 2018. The meeting intended to update the ten-year-old safety guidelines for the application of transcranial magnetic stimulation (TMS) in research and clinical settings (Rossi et al., 2009). Therefore, only emerging and new issues are covered in detail, leaving still valid the 2009 recommendations regarding the description of conventional or patterned TMS protocols, the screening of subjects/patients, the need of neurophysiological monitoring for new protocols, the utilization of reference thresholds of stimulation, the managing of seizures and the list of minor side effects. New issues discussed in detail from the meeting up to April 2020 are safety issues of recently developed stimulation devices and pulse configurations; duties and responsibility of device makers; novel scenarios of TMS applications such as in the neuroimaging context or imaging-guided and robot-guided TMS; TMS interleaved with transcranial electrical stimulation; safety during paired associative stimulation interventions; and risks of using TMS to induce therapeutic seizures (magnetic seizure therapy). An update on the possible induction of seizures, theoretically the most serious risk of TMS, is provided. It has become apparent that such a risk is low, even in patients taking drugs acting on the central nervous system, at least with the use of traditional stimulation parameters and focal coils for which large data sets are available. Finally, new operational guidelines are provided for safety in planning future trials based on traditional and patterned TMS protocols, as well as a summary of the minimal training requirements for operators, and a note on ethics of neuroenhancement.
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Affiliation(s)
- Simone Rossi
- Department of Scienze Mediche, Chirurgiche e Neuroscienze, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab (SI-BIN Lab), University of Siena, Italy.
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center, Georg-August University of Goettingen, Germany; Institue of Medical Psychology, Otto-Guericke University Magdeburg, Germany
| | - Sven Bestmann
- Department of Movement and Clinical Neurosciences, UCL Queen Square Institute of Neurology, London, UK and Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - Carmen Brewer
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jürgen Brockmöller
- Department of Clinical Pharmacology, University Medical Center, Georg-August University of Goettingen, Germany
| | - Linda L Carpenter
- Butler Hospital, Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Massimo Cincotta
- Unit of Neurology of Florence - Central Tuscany Local Health Authority, Florence, Italy
| | - Robert Chen
- Krembil Research Institute and Division of Neurology, Department of Medicine, University of Toronto, Canada
| | - Jeff D Daskalakis
- Center for Addiction and Mental Health (CAMH), University of Toronto, Canada
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico, Roma, Italy
| | - Michael D Fox
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Mark S George
- Medical University of South Carolina, Charleston, SC, USA
| | - Donald Gilbert
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | | | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering (NBE), Aalto University School of Science, Aalto, Finland
| | - Jean Pascal Lefaucheur
- EA 4391, ENT Team, Faculty of Medicine, Paris Est Creteil University (UPEC), Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, (APHP), Créteil, France
| | - Letizia Leocani
- Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS-San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Sarah H Lisanby
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Carlo Miniussi
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew SeniorLife, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Guttmann Brain Health Institut, Institut Guttmann, Universitat Autonoma Barcelona, Spain
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg-August University of Goettingen, Germany
| | - Angel V Peterchev
- Departments of Psychiatry & Behavioral Sciences, Biomedical Engineering, Electrical & Computer Engineering, and Neurosurgery, Duke University, Durham, NC, USA
| | - Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Alexander Rotenberg
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - John Rothwell
- Department of Movement and Clinical Neurosciences, UCL Queen Square Institute of Neurology, London, UK and Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Paolo M Rossini
- Department of Neuroscience and Rehabilitation, IRCCS San Raffaele-Pisana, Roma, Italy
| | - Emiliano Santarnecchi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mouhsin M Shafi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Yoshikatzu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Eric M Wassermann
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Abraham Zangen
- Zlotowski Center of Neuroscience, Ben Gurion University, Beer Sheva, Israel
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA.
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11
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Recovery of reward function in problematic substance users using a combination of robotics, electrophysiology, and TMS. Int J Psychophysiol 2020; 158:288-298. [DOI: 10.1016/j.ijpsycho.2020.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/12/2020] [Accepted: 08/24/2020] [Indexed: 02/08/2023]
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12
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Giuffre A, Kahl CK, Zewdie E, Wrightson JG, Bourgeois A, Condliffe EG, Kirton A. Reliability of robotic transcranial magnetic stimulation motor mapping. J Neurophysiol 2020; 125:74-85. [PMID: 33146067 DOI: 10.1152/jn.00527.2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Robotic transcranial magnetic stimulation (TMS) is a noninvasive and safe tool that produces cortical motor maps using neuronavigational and neuroanatomical images. Motor maps are individualized representations of the primary motor cortex (M1) topography that may reflect developmental and interventional plasticity. Results of TMS motor map reliability testing have been variable, and robotic measures are undefined. We aimed to determine the short- and long-term reliability of robotic TMS motor maps. Twenty healthy participants underwent motor mapping at baseline, 24 h, and 4 wk. A 12 × 12 grid (7-mm spacing) was placed over the left M1, centered over the hand knob area. Four suprathreshold stimulations were delivered at each grid point. First dorsal interosseous (FDI) motor-evoked potentials (MEPs) were analyzed offline to generate map characteristics of area, volume, center of gravity (COG), and hotspot magnitude. Subsets of each outcome corresponding to 75%, 50%, and 25% of each map were determined. Reliability measures including intraclass correlation coefficient (ICC), minimal detectable change (MDC), and standard error of measure (SEM) were calculated. Map volume, COG, and hotspot magnitude were the most reliable measures (good-to-excellent) over both short- and long-term sessions. Map area reliability was poor-to-moderate for short- and long-term sessions. Smaller map percentile subsets showed decreased variability but only minimal improvements in reliability. MDC for most outcomes was >50%. Procedures were well tolerated with no serious adverse events. Robotic TMS motor mapping is relatively reliable over time, but careful consideration of specific outcomes is required for this method to interrogate plasticity in the human motor system.NEW & NOTEWORTHY Robotic transcranial magnetic stimulation (TMS) is a noninvasive and safe tool that produces cortical motor maps-individualized representations of the primary motor cortex (M1) topography-that may reflect developmental and interventional plasticity. This study is the first to evaluate short- and long-term relative and absolute reliability of TMS mapping outcomes at various M1 excitability levels using novel robotic neuronavigated TMS.
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Affiliation(s)
- Adrianna Giuffre
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia K Kahl
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ephrem Zewdie
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James G Wrightson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anna Bourgeois
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Elizabeth G Condliffe
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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13
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Jeltema HR, Ohlerth AK, de Wit A, Wagemakers M, Rofes A, Bastiaanse R, Drost G. Comparing navigated transcranial magnetic stimulation mapping and "gold standard" direct cortical stimulation mapping in neurosurgery: a systematic review. Neurosurg Rev 2020; 44:1903-1920. [PMID: 33009990 PMCID: PMC8338816 DOI: 10.1007/s10143-020-01397-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 09/05/2020] [Accepted: 09/17/2020] [Indexed: 12/14/2022]
Abstract
The objective of this systematic review is to create an overview of the literature on the comparison of navigated transcranial magnetic stimulation (nTMS) as a mapping tool to the current gold standard, which is (intraoperative) direct cortical stimulation (DCS) mapping. A search in the databases of PubMed, EMBASE, and Web of Science was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recommendations were used. Thirty-five publications were included in the review, describing a total of 552 patients. All studies concerned either mapping of motor or language function. No comparative data for nTMS and DCS for other neurological functions were found. For motor mapping, the distances between the cortical representation of the different muscle groups identified by nTMS and DCS varied between 2 and 16 mm. Regarding mapping of language function, solely an object naming task was performed in the comparative studies on nTMS and DCS. Sensitivity and specificity ranged from 10 to 100% and 13.3–98%, respectively, when nTMS language mapping was compared with DCS mapping. The positive predictive value (PPV) and negative predictive value (NPV) ranged from 17 to 75% and 57–100% respectively. The available evidence for nTMS as a mapping modality for motor and language function is discussed.
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Affiliation(s)
- Hanne-Rinck Jeltema
- Department of Neurosurgery, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
| | - Ann-Katrin Ohlerth
- Center for Language and Cognition Groningen, University of Groningen, Oude Kijk in 't Jatstraat 26, 9712 EK, Groningen, the Netherlands
| | - Aranka de Wit
- Faculty of Medical Sciences, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
| | - Michiel Wagemakers
- Department of Neurosurgery, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Adrià Rofes
- Center for Language and Cognition Groningen, University of Groningen, Oude Kijk in 't Jatstraat 26, 9712 EK, Groningen, the Netherlands
| | - Roelien Bastiaanse
- Center for Language and Cognition Groningen, University of Groningen, Oude Kijk in 't Jatstraat 26, 9712 EK, Groningen, the Netherlands.,Center for Language and Brain, National Research University, Higher School of Economics, Moscow, Russian Federation
| | - Gea Drost
- Department of Neurosurgery, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
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14
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Faghihpirayesh R, Imbiriba T, Yarossi M, Tunik E, Brooks D, Erdoğmuş D. Motor Cortex Mapping using Active Gaussian Processes. THE ... INTERNATIONAL CONFERENCE ON PERVASIVE TECHNOLOGIES RELATED TO ASSISTIVE ENVIRONMENTS : PETRA ... INTERNATIONAL CONFERENCE ON PERVASIVE TECHNOLOGIES RELATED TO ASSISTIVE ENVIRONMENTS 2020; 2020:14. [PMID: 32832934 PMCID: PMC7433704 DOI: 10.1145/3389189.3389202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
One important application of transcranial magnetic stimulation (TMS) is to map cortical motor topography by spatially sampling the motor cortex, and recording motor evoked potentials (MEP) with surface electromyography. Standard approaches to TMS mapping involve repetitive stimulations at different loci spaced on a (typically 1 cm) grid on the scalp. These mappings strategies are time consuming and responsive sites are typically sparse. Furthermore, the long time scale prevents measurement of transient cortical changes, and is poorly tolerated in clinical populations. An alternative approach involves using the TMS mapper expertise to exploit the map's sparsity through the use of feedback of MEPs to decide which loci to stimulate. In this investigation, we propose a novel active learning method to automatically infer optimal future stimulus loci in place of user expertise. Specifically, we propose an active Gaussian Process (GP) strategy with loci selection criteria such as entropy and mutual information (MI). The proposed method twists the usual entropy- and MI-based selection criteria by modeling the estimated MEP field, i.e., the GP mean, as a Gaussian random variable itself. By doing so, we include MEP amplitudes in the loci selection criteria which would be otherwise completely independent of the MEP values. Experimental results using real data shows that the proposed strategy can greatly outperform competing methods when the MEP variations are mostly conned in a sub-region of the space.
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Affiliation(s)
| | | | | | - Eugene Tunik
- PTRMS, Northeastern University, Boston, Massachusetts
| | - Dana Brooks
- ECE, Northeastern University, Boston, Massachusetts
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15
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Goetz SM, Kozyrkov IC, Luber B, Lisanby SH, Murphy DLK, Grill WM, Peterchev AV. Accuracy of robotic coil positioning during transcranial magnetic stimulation. J Neural Eng 2019; 16:054003. [PMID: 31189147 DOI: 10.1088/1741-2552/ab2953] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Robotic positioning systems for transcranial magnetic stimulation (TMS) promise improved accuracy and stability of coil placement, but there is limited data on their performance. Investigate the usability, accuracy, and limitations of robotic coil placement with a commercial system, ANT Neuro, in a TMS study. APPROACH 21 subjects underwent a total of 79 TMS sessions corresponding to 160 hours under robotic coil control. Coil position and orientation were monitored concurrently through an additional neuronavigation system. MAIN RESULTS Robot setup took on average 14.5 min. The robot achieved low position and orientation error with median 3.54 mm (overall, 1.34 mm without coil-head spacing) and 3.48°. The error increased over time at a rate of 0.4%/minute for both position and orientation. SIGNIFICANCE Robotic TMS systems can provide accurate and stable coil position and orientation in long TMS sessions. Lack of pressure feedback and of manual adjustment of all coil degrees of freedom were limitations of this robotic system.
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Affiliation(s)
- Stefan M Goetz
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, United States of America. Department of Neurosurgery, Duke University, Durham, NC 27710, United States of America. Department of Electrical and Computer Engineering, Duke University, Durham, NC 27708, United States of America
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16
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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-CLINICAL 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] [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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17
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Grab J, Zewdie E, Carlson H, Kuo HC, Ciechanski P, Hodge J, Giuffre A, Kirton A. Robotic TMS mapping of motor cortex in the developing brain. J Neurosci Methods 2018; 309:41-54. [DOI: 10.1016/j.jneumeth.2018.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 12/22/2022]
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18
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Wang H, Jin J, Wang X, Li Y, Liu Z, Yin T. Non-orthogonal one-step calibration method for robotized transcranial magnetic stimulation. Biomed Eng Online 2018; 17:137. [PMID: 30285787 PMCID: PMC6167805 DOI: 10.1186/s12938-018-0570-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Robotized transcranial magnetic stimulation (TMS) combines the benefits of neuro-navigation with automation and provides a precision brain stimulation method. Since the coil will normally remain unmounted between different clinical uses, hand/eye calibration and coil calibration are required before each experiment. Today, these two steps are still separate: hand/eye calibration is performed using methods proposed by Tsai/Lenz or Floris Ernst, and then the coil calibration is carried out based on the traditional TMS experimental step. The process is complex and time-consuming, and traditional coil calibration using a handheld probe is susceptible to greater calibration error. METHODS A novel one-step calibration method has been developed to confirm hand/eye and coil calibration results by formulating a matrix equation system and estimating its solution. Hand/eye calibration and coil calibration are performed to confirm the pose relationships of the marker/end effector 'X', probe/end effector 'Y', and robot/world 'Z'. First, the coil is fixed on the end effector of the robot. During the one-step calibration process, a marker is mounted on the top of the coil and a calibration probe is fixed at the actual effective position of the coil. Next, the robot end effector is moved to a series of random positions 'A', the tracking data of marker 'B' and probe 'C' is obtained correspondingly. Then, a matrix equation system AX = ZB and AY = ZC can be acquired, and it is computed using a least-squares approach. Finally, the calibration probe is removed after calibration, while the marker remains fixed to the coil during the TMS experiment. The methods were evaluated based on simulation data and on experimental data from an optical tracking device. We compared our methods with two classical methods: the QR24 method proposed by Floris Ernst and the handheld coil calibration method. RESULTS The new methods outperform the QR24 method in the aspect of translational accuracy and performs similarly in the aspect of rotational accuracy, the total translational error decreased more than fifty percent. The new approach also outperforms traditional handheld coil calibration of navigated TMS systems, the total translational error decreased three- to fourfold, and the rotational error decreased six- to eightfold. Furthermore, the convergence speed is improved 16- to 27-fold for the new algorithms. CONCLUSION These results suggest that the new method can be used for hand/eye and coil calibration of a robotized TMS system. Two complex steps can be simplified using a least-squares approach.
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Affiliation(s)
- He Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, 300192, China
| | - Jingna Jin
- Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, 300192, China
| | - Xin Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, 300192, China
| | - Ying Li
- Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, 300192, China
| | - Zhipeng Liu
- Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, 300192, China
| | - Tao Yin
- Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, 300192, China. .,Neuroscience Center, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, China.
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19
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Noccaro A, Raiano L, Di Pino G, Formica D. Evaluation of hand-eye and robot-world calibration algorithms for TMS application. PROCEEDINGS OF THE ... IEEE/RAS-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL ROBOTICS AND BIOMECHATRONICS. IEEE/RAS-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL ROBOTICS AND BIOMECHATRONICS 2018; 2018:1115-1119. [PMID: 30949403 DOI: 10.1109/biorob.2018.8487930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this paper we compare three approaches to solve the hand-eye and robot-world calibration problem, for their application to a Transcranial Magnetic Stimulation (TMS) system. The selected approaches are: i) non-orthogonal approach (QR24); ii) stochastic global optimization (SGO); iii) quaternion-based (QUAT) method. Performance were evaluated in term of translation and rotation errors, and computational time. The experimental setup is composed of a 7 dof Panda robot (by Franka Emika GmbH) and a Polaris Vicra camera (by Northern Digital Inc) combined with the SofTaxic Optic software (by E.M.S. srl). The SGO method resulted to have the best performance, since it provides lowest errors and high stability over different datasets and number of calibration points. The only drawback is its computational time, which is higher than the other two, but this parameter is not relevant for TMS application. Over the different dataset used in our tests, the small workspace (sphere with radius of 0.05m) and a number of calibration points around 150 allow to achieve the best performance with the SGO method, with an average error of 0.83 ± 0.35mm for position and 0.22 ± 0.12deg for orientation.
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Affiliation(s)
- A Noccaro
- Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Universitá Campus Bio-Medico di Roma, Rome, Italy
| | - L Raiano
- Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Universitá Campus Bio-Medico di Roma, Rome, Italy
| | - G Di Pino
- Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Universitá Campus Bio-Medico di Roma, Rome, Italy
| | - D Formica
- Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Universitá Campus Bio-Medico di Roma, Rome, Italy
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20
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Meincke J, Hewitt M, Reischl M, Rupp R, Schmidt-Samoa C, Liebetanz D. Cortical representation of auricular muscles in humans: A robot-controlled TMS mapping and fMRI study. PLoS One 2018; 13:e0201277. [PMID: 30052653 PMCID: PMC6065161 DOI: 10.1371/journal.pone.0201277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 07/12/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Most humans have the ability to activate the auricular muscles. Although (intentional) control suggests an involvement of higher cortical centers underlying posterior auricular muscle (PAM) activation, the cortical representation of the auricular muscles is still unknown. METHODS With the purpose of identifying a possible cortical representation area we performed automated robotic and image-guided transcranial magnetic stimulation (TMS) mapping (n = 8) and functional magnetic resonance imaging (fMRI) (n = 13). For topographical comparison, a similar experimental protocol was applied for the first dorsal interosseus muscle (FDI) of the hand. RESULTS The calculated centers of gravity (COGs) of both muscles were located on the precentral gyrus with the PAM COGs located more laterally compared to the FDI. The distance between the mean PAM and mean FDI COG was 26.3 mm. The TMS mapping results were confirmed by fMRI, which showed a dominance of cortical activation within the precentral gyrus during the corresponding motor tasks. The correspondence of TMS and fMRI results was high. CONCLUSION The involvement of the primary motor cortex in PAM activation might point to an evolved function of the auricular muscles in humans and/or the ability of intentional (and selective) muscle activation.
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Affiliation(s)
- Jonna Meincke
- Clinic of Clinical Neurophysiology, Georg August University of Göttingen,
University Medical Center, Göttingen, Germany
| | - Manuel Hewitt
- Clinic of Clinical Neurophysiology, Georg August University of Göttingen,
University Medical Center, Göttingen, Germany
| | - Markus Reischl
- Institute for Applied Computer Science, Karlsruhe Institute of
Technology, Eggenstein-Leopoldshafen, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg,
Germany
| | - Carsten Schmidt-Samoa
- Department of Cognitive Neurology, Georg August University of Göttingen,
University Medical Center, Göttingen, Germany
| | - David Liebetanz
- Clinic of Clinical Neurophysiology, Georg August University of Göttingen,
University Medical Center, Göttingen, Germany
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21
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Koponen LM, Nieminen JO, Ilmoniemi RJ. Multi-locus transcranial magnetic stimulation-theory and implementation. Brain Stimul 2018; 11:849-855. [PMID: 29627272 DOI: 10.1016/j.brs.2018.03.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/09/2018] [Accepted: 03/20/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation method: a magnetic field pulse from a TMS coil can excite neurons in a desired location of the cortex. Conventional TMS coils cause focal stimulation underneath the coil centre; to change the location of the stimulated spot, the coil must be moved over the new target. This physical movement is inherently slow, which limits, for example, feedback-controlled stimulation. OBJECTIVE To overcome the limitations of physical TMS-coil movement by introducing electronic targeting. METHODS We propose electronic stimulation targeting using a set of large overlapping coils and introduce a matrix-factorisation-based method to design such sets of coils. We built one such device and demonstrated the electronic stimulation targeting in vivo. RESULTS The demonstrated two-coil transducer allows translating the stimulated spot along a 30-mm-long line segment in the cortex; with five coils, a target can be selected from within a region of the cortex and stimulated in any direction. Thus, far fewer coils are required by our approach than by previously suggested ones, none of which have resulted in practical devices. CONCLUSION Already with two coils, we can adjust the location of the induced electric field maximum along one dimension, which is sufficient to study, for example, the primary motor cortex.
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Affiliation(s)
- Lari M Koponen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaakko O Nieminen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Takakura T, Muragaki Y, Tamura M, Maruyama T, Nitta M, Niki C, Kawamata T. Navigated transcranial magnetic stimulation for glioma removal: prognostic value in motor function recovery from postsurgical neurological deficits. J Neurosurg 2017; 127:877-891. [PMID: 28059664 DOI: 10.3171/2016.8.jns16442] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the usefulness of navigated transcranial magnetic stimulation (nTMS) as a prognostic predictor for upper-extremity motor functional recovery from postsurgical neurological deficits. METHODS Preoperative and postoperative nTMS studies were prospectively applied in 14 patients (mean age 39 ± 12 years) who had intraparenchymal brain neoplasms located within or adjacent to the motor eloquent area in the cerebral hemisphere. Mapping by nTMS was done 3 times, i.e., before surgery, and 1 week and 3 weeks after surgery. To assess the response induced by nTMS, motor evoked potential (nTMS-MEP) was recorded using a surface electromyography electrode attached to the abductor pollicis brevis (APB). The cortical locations that elicited the largest electromyography response by nTMS were defined as hotspots. Hotspots for APB were confirmed as positive responsive sites by direct electrical stimulation (DES) during awake craniotomy. The distances between hotspots and lesions (DHS-L) were measured. Postoperative neurological deficits were assessed by manual muscle test and dynamometer. To validate the prognostic value of nTMS in recovery from upper-extremity paresis, the following were investigated: 1) the correlation between DHS-L and the serial grip strength change, and 2) the correlation between positive nTMS-MEP at 1 week after surgery and the serial grip strength change. RESULTS From the presurgical nTMS study, MEPs from targeted muscles were identified in 13 cases from affected hemispheres. In one case, MEP was not evoked due to a huge tumor. Among 9 cases from which intraoperative DES mapping for hand motor area was available, hotspots for APB identified by nTMS were concordant with DES-positive sites. Compared with the adjacent group (DHS-L < 10 mm, n = 6), the nonadjacent group (DHS-L ≥ 10 mm, n = 7) showed significantly better recovery of grip strength at 3 months after surgery (p < 0.01). There were correlations between DHS-L and recovery of grip strength at 1 week, 3 weeks, and 3 months after surgery (r = 0.74, 0.68, and 0.65, respectively). Postsurgical nTMS was accomplished in 13 patients. In 9 of 13 cases, nTMS-MEP from APB muscle was positive at 1 week after surgery. Excluding the case in which nTMS-MEP was negative from the presurgical nTMS study, recoveries in grip strength were compared between 2 groups, in which nTMS-MEP at 1 week after surgery was positive (n = 9) or negative (n = 3). Significant differences were observed between the 2 groups at 1 week, 3 weeks, and 3 months after surgery (p < 0.01). Positive nTMS-MEP at 1 week after surgery correlated well with the motor recovery at 1 week, 3 weeks, and 3 months after surgery (r = 0.87, 0.88, and 0.77, respectively). CONCLUSIONS Navigated TMS is a useful tool for identifying motor eloquent areas. The results of the present study have demonstrated the predictive value of nTMS in upper-extremity motor function recovery from postsurgical neurological deficits. The longer DHS-L and positive nTMS-MEP at 1 week after surgery have prognostic values of better recovery from postsurgical neurological deficits.
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Affiliation(s)
- Tomokazu Takakura
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of Medicine.,Department of Physical Medicine and Rehabilitation, Tokyo Rosai Hospital, Tokyo, Japan
| | - Yoshihiro Muragaki
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of Medicine.,Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University; and
| | - Manabu Tamura
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of Medicine.,Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University; and
| | - Takashi Maruyama
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of Medicine.,Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University; and
| | - Masayuki Nitta
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of Medicine.,Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University; and
| | - Chiharu Niki
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University; and
| | - Takakazu Kawamata
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University; and
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23
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Sollmann N, Goblirsch-Kolb MF, Ille S, Butenschoen VM, Boeckh-Behrens T, Meyer B, Ringel F, Krieg SM. Comparison between electric-field-navigated and line-navigated TMS for cortical motor mapping in patients with brain tumors. Acta Neurochir (Wien) 2016; 158:2277-2289. [PMID: 27722947 DOI: 10.1007/s00701-016-2970-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 09/12/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND For the navigation of transcranial magnetic stimulation (TMS), various techniques are available. Yet, there are two basic principles underlying them all: electric-field-navigated transcranial magnetic stimulation (En-TMS) and line-navigated transcranial magnetic stimulation (Ln-TMS). The current study was designed to compare both methods. METHODS To explore whether there is a difference in clinical applicability, workflow, and mapping results of both techniques, we systematically compared motor mapping via En-TMS and Ln-TMS in 12 patients suffering from brain tumors. RESULTS The number of motor-positive stimulation spots and the ratio of positive spots per overall stimulation numbers were significantly higher for En-TMS (motor-positive spots: En-TMS vs. Ln-TMS: 128.3 ± 35.0 vs. 41.3 ± 26.8, p < 0.0001; ratio of motor-positive spots per number of stimulations: En-TMS vs. Ln-TMS: 38.0 ± 9.2 % vs. 20.0 ± 14.4 %, p = 0.0031). Distances between the En-TMS and Ln-TMS motor hotspots were 8.3 ± 4.4 mm on the ipsilesional and 8.6 ± 4.5 mm on the contralesional hemisphere (p = 0.9124). CONCLUSIONS The present study compares En-TMS and Ln-TMS motor mapping in the neurosurgical context for the first time. Although both TMS systems tested in the present study are explicitly designed for application during motor mapping in patients with brain lesions, there are differences in applicability, workflow, and results between En-TMS and Ln-TMS, which should be distinctly considered during clinical use of the technique. However, to draw final conclusions about accuracy, confirmation of motor-positive Ln-TMS spots by intraoperative stimulation is crucial within the scope of upcoming investigations.
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Ahdab R, Ayache SS, Brugières P, Farhat WH, Lefaucheur JP. The Hand Motor Hotspot is not Always Located in the Hand Knob: A Neuronavigated Transcranial Magnetic Stimulation Study. Brain Topogr 2016; 29:590-7. [PMID: 26980192 DOI: 10.1007/s10548-016-0486-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
Abstract
The hand motor hot spot (hMHS) is one of the most salient parameters in transcranial magnetic stimulation (TMS) practice, notably used for targeting. It is commonly accepted that the hMHS corresponds to the hand representation within the primary motor cortex (M1). Anatomical and imaging studies locate this representation in a region of the central sulcus called the "hand knob". The aim of this study was to determine if the hMHS location corresponds to its expected location at the hand knob. Twelve healthy volunteers and eleven patients with chronic neuropathic pain of various origins, but not related to a brain lesion, were enrolled. Morphological magnetic resonance imaging of the brain was normal in all participants. Both hemispheres were studied in all participants except four (two patients and two healthy subjects). Cortical mapping of the hand motor area was conducted using a TMS-dedicated navigation system and recording motor evoked potentials (MEPs) in the contralateral first dorsal interosseous (FDI) muscle. We then determined the anatomical position of the hMHS, defined as the stimulation site providing the largest FDI-MEPs. In 45 % of hemispheres of normal subjects and 25 % of hemispheres of pain patients, the hMHS was located over the central sulcus, most frequently at the level of the hand knob. However, in the other cases, the hMHS was located outside M1, most frequently anteriorly over the precentral or middle frontal gyrus. This study shows that the hMHS does not always correspond to the hand knob and M1 location in healthy subjects or patients. Therefore, image-guided navigation is needed to improve the anatomical accuracy of TMS targeting, even for M1.
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Affiliation(s)
- Rechdi Ahdab
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France.,Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France.,Neurology Division, University Medical Center Rizk Hospital, Beirut, Lebanon
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France. .,Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France. .,Neurology Division, University Medical Center Rizk Hospital, Beirut, Lebanon.
| | - Pierre Brugières
- Service de Neuroradiologie, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Wassim H Farhat
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France.,Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France
| | - Jean-Pascal Lefaucheur
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France.,Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France
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25
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Meincke J, Hewitt M, Batsikadze G, Liebetanz D. Automated TMS hotspot-hunting using a closed loop threshold-based algorithm. Neuroimage 2016; 124:509-517. [DOI: 10.1016/j.neuroimage.2015.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/28/2015] [Accepted: 09/07/2015] [Indexed: 01/30/2023] Open
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26
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Picht T. Current and potential utility of transcranial magnetic stimulation in the diagnostics before brain tumor surgery. CNS Oncol 2015; 3:299-310. [PMID: 25286041 DOI: 10.2217/cns.14.25] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This article describes the evolution and state-of-the-art of navigated transcranial magnetic stimulation for evaluation of patients with brain tumors in presumed eloquent location. Alternative noninvasive technologies for functional brain mapping are described and assessed in the context of their usability and clinical needs. In addition to the description of the current validation level and clinical application of navigated transcranial magnetic stimulation for motor and language mapping, the manuscript highlights ongoing research efforts and provides an outlook on upcoming developments in the field of noninvasive brain mapping. Finally, the clinical rationale for presurgical noninvasive brain mapping is discussed in the light of current developments in neurosurgery.
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27
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Peterchev AV, Deng ZD, Goetz SM. Advances in Transcranial Magnetic Stimulation Technology. Brain Stimul 2015. [DOI: 10.1002/9781118568323.ch10] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Magro E, Moreau T, Seizeur R, Zemmoura I, Gibaud B, Morandi X. Connectivity within the primary motor cortex: a DTI tractography study. Surg Radiol Anat 2013; 36:125-35. [PMID: 23820893 DOI: 10.1007/s00276-013-1160-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Because of the motor function of the precentral area, the connections of the primary motor cortex by white matter fiber bundles have been widely studied in diffusion tensor imaging (DTI). Nevertheless, the connections within the primary motor cortex have yet to be explored. We have studied the connectivity between the different regions of the precentral gyrus in a population of subjects. METHODS Based on T1 magnetic resonance imaging (MRI) and on individual sulco-gyral anatomy, we defined a parcellation of the right and the left precentral gyri in 20 healthy subjects (10 right-handers; 10 left-handers). This parcellation gave us the opportunity to study MRI tracks reconstructed by tractography within the precentral gyrus and to compare these connections across subjects. We also performed a classical dissection of post-mortem brain tissue to isolate this pattern of connectivity. RESULTS We showed MRI tracks connecting the different parts of the same precentral gyrus. This result was reproducible and was found in the left and right hemispheres of the 20 subjects. A quantitative description of the bilateral distribution of the MRI tracks was performed, based on statistical analysis and asymmetry indices, to compare asymmetry and handedness. CONCLUSIONS To the best of our knowledge, this pattern of connectivity has never before been detailed in the literature. Its functional meaning remains to be determined, which requires further study.
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Affiliation(s)
- Elsa Magro
- Service de Neurochirurgie, CHRU Cavale Blanche, 29200, Brest, France,
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30
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Kantelhardt SR, Finke M, Schweikard A, Giese A. Evaluation of a completely robotized neurosurgical operating microscope. Neurosurgery 2013; 72 Suppl 1:19-26. [PMID: 23254808 DOI: 10.1227/neu.0b013e31827235f8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Operating microscopes are essential for most neurosurgical procedures. Modern robot-assisted controls offer new possibilities, combining the advantages of conventional and automated systems. OBJECTIVE We evaluated the prototype of a completely robotized operating microscope with an integrated optical coherence tomography module. METHODS A standard operating microscope was fitted with motors and control instruments, with the manual control mode and balance preserved. In the robot mode, the microscope was steered by a remote control that could be fixed to a surgical instrument. External encoders and accelerometers tracked microscope movements. The microscope was additionally fitted with an optical coherence tomography-scanning module. RESULTS The robotized microscope was tested on model systems. It could be freely positioned, without forcing the surgeon to take the hands from the instruments or avert the eyes from the oculars. Positioning error was about 1 mm, and vibration faded in 1 second. Tracking of microscope movements, combined with an autofocus function, allowed determination of the focus position within the 3-dimensional space. This constituted a second loop of navigation independent from conventional infrared reflector-based techniques. In the robot mode, automated optical coherence tomography scanning of large surface areas was feasible. CONCLUSION The prototype of a robotized optical coherence tomography-integrated operating microscope combines the advantages of a conventional manually controlled operating microscope with a remote-controlled positioning aid and a self-navigating microscope system that performs automated positioning tasks such as surface scans. This demonstrates that, in the future, operating microscopes may be used to acquire intraoperative spatial data, volume changes, and structural data of brain or brain tumor tissue.
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Affiliation(s)
- Sven R Kantelhardt
- Department of Neurosurgery, Johannes Gutenberg-University Mainz, Mainz, Germany.
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Takahashi S, Vajkoczy P, Picht T. Navigated transcranial magnetic stimulation for mapping the motor cortex in patients with rolandic brain tumors. Neurosurg Focus 2013; 34:E3. [PMID: 23544409 DOI: 10.3171/2013.1.focus133] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Navigated transcranial magnetic stimulation (nTMS) is a novel technology in the field of neurosurgery for noninvasive delineation of cortical functional topography. This study addresses the spatial accuracy and clinical usefulness of nTMS in brain tumor surgery in or near the motor cortex based on a systematic review of observational studies.
Methods
A systematic search retrieved 11 reports published up to October 2012 in which adult patients were examined with nTMS prior to surgery. Quality criteria consisted of documentation of the influence of nTMS brain mapping on clinical decision making in a standardized prospective manner and/or performance of intraoperative direct electrical stimulation (DES) and comparison with nTMS results. Cross-observational assessment of nTMS accuracy was established by calculating a weighted mean distance between nTMS and DES.
Results
All studies reviewed in this article concluded that nTMS correlated well with the “gold standard” of DES. The mean distance between motor cortex identified on nTMS and DES by using the mean distance in 81 patients described in 6 quantitatively evaluated studies was 6.18 mm. The nTMS results changed the surgical strategy based on anatomical imaging alone in 25.3% of all patients, based on the data obtained in 87 patients in 2 studies.
Conclusions
The nTMS technique spatially correlates well with the gold standard of DES. Its functional information benefits surgical decision making and changes the treatment strategy in one-fourth of cases.
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Paiva WS, Fonoff ET, Marcolin MA, Bor-Seng-Shu E, Figueiredo EG, Teixeira MJ. Navigated transcranial magnetic stimulation in preoperative planning for the treatment of motor area cavernous angiomas. Neuropsychiatr Dis Treat 2013; 9:1885-8. [PMID: 24353424 PMCID: PMC3862695 DOI: 10.2147/ndt.s43644] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Since the introduction of microscopic techniques, radical surgery for cavernous angiomas has become a recommended treatment option. However, the treatment of motor area cavernous angioma represents a great challenge for the surgical team. Here, we describe an approach guided by frameless neuronavigation and preoperative functional mapping with transcranial magnetic stimulation (TMS), for surgical planning. We used TMS to map the motor cortex and its relationship with the angioma. We achieved complete resection of the lesions in the surgeries, while avoiding areas of motor response identified during the preoperative mapping. We verified the complete control of seizures (Engel class 1A) in the patients with previous refractory epilepsy. Postsurgery, one patient was seizure-free without medication, and two patients required only one medication for seizure control. Thus, navigated TMS appears to be a useful tool, in preoperative planning for cavernous angiomas of the motor area.
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Affiliation(s)
- Wellingson Silva Paiva
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Erich Talamoni Fonoff
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Marco Antonio Marcolin
- Transcranial Magnetic Stimulation Laboratory, Institute of Psychiatry, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Edson Bor-Seng-Shu
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Eberval Gadelha Figueiredo
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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Coburger J, Musahl C, Henkes H, Horvath-Rizea D, Bittl M, Weissbach C, Hopf N. Comparison of navigated transcranial magnetic stimulation and functional magnetic resonance imaging for preoperative mapping in rolandic tumor surgery. Neurosurg Rev 2012; 36:65-75; discussion 75-6. [DOI: 10.1007/s10143-012-0413-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 05/21/2012] [Accepted: 06/16/2012] [Indexed: 10/28/2022]
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Kantelhardt SR, Greke C, Keric N, Vollmer F, Thiemann I, Giese A. Image guidance for transcranial Doppler ultrasonography. Neurosurgery 2012; 68:257-66; discussion 266. [PMID: 21389880 DOI: 10.1227/neu.0b013e31821553b2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Transcranial Doppler (TCD) ultrasonography is an important tool for noninvasive detection and monitoring of vasospasm and other pathological conditions of the intracranial vessels. OBJECTIVE To demonstrate that image-guided TCD allows rapid identification and blood-flow analysis of specific sections of the vascular anatomy and provides excellent orientation, also allowing diagnostic procedures on pathological vascular structures. METHODS Three patients who underwent computed tomographic angiography scanning for reasons not related to this study were examined by neuronavigated image-guided TCD. The Doppler probe was fitted with reflective markers and tracked by a commercially available Kolibri image guidance system. RESULTS Image-guided TCD allowed identification of all major intracranial vessels. Unilateral acquisition of reliable Doppler signals for the internal carotid artery, carotid T, middle cerebral artery, middle cerebral artery bifurcation, and anterior cerebral artery required 14 ± 6 minutes. Preregistration of these targets and detection by neuronavigation alone shortened examination times significantly to 8 ± 2 minutes. Registering the optimal examination trajectories on the neuronavigational device and applying navigational pilot software shortened times for repetitive examination further to 4 ± 1 minutes and ensured that the examination was done at the exact same spot under the same angle as in previous examinations. CONCLUSION Image guidance can be applied easily and efficiently to TCD. It provides anatomic orientation and may help to standardize investigation protocols, define pathological vascular territories for repeat investigations, and thus reduce interinvestigator variations. Image guidance may also extend the use of TCD to situations of a pathological or variant vascular anatomy.
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Affiliation(s)
- Sven R Kantelhardt
- Department of Neurosurgery, Georg-August-University of Göttingen, Robert-Koch-Strasse 40, Göttingen, Germany
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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] [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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Zorn L, Renaud P, Bayle B, Goffin L, Lebosse C, de Mathelin M, Foucher J. Design and Evaluation of a Robotic System for Transcranial Magnetic Stimulation. IEEE Trans Biomed Eng 2012; 59:805-15. [DOI: 10.1109/tbme.2011.2179938] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Najib U, Bashir S, Edwards D, Rotenberg A, Pascual-Leone A. Transcranial brain stimulation: clinical applications and future directions. Neurosurg Clin N Am 2011; 22:233-51, ix. [PMID: 21435574 PMCID: PMC3547606 DOI: 10.1016/j.nec.2011.01.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Noninvasive brain stimulation is a valuable investigative tool and has potential therapeutic applications in cognitive neuroscience, neurophysiology, psychiatry, and neurology. Transcranial magnetic stimulation (TMS) is particularly useful to establish and map causal brain-behavior relations in motor and nonmotor cortical areas. Neuronavigated TMS is able to provide precise information related to the individual's functional anatomy that can be visualized and used during surgical interventions and critically aid in presurgical planning, reducing the need for riskier and more cumbersome intraoperative or invasive mapping procedures. This article reviews methodological aspects, clinical applications, and future directions of TMS-based mapping.
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Affiliation(s)
- Umer Najib
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Shahid Bashir
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Dylan Edwards
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
- Non-Invasive Brain Stimulation and the Human Motor Control Laboratory, Burke Medical Research Institute, Inc, 785 Mamaroneck Avenue, White Plains, NY 10605, USA
| | - Alexander Rotenberg
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
- Institut Guttman de Neurorehabilitació, Institut Universitari, Universitat Autonoma de Barcelona, Camí de Can Ruti s/n, 08916 Badalona, Spain
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Picht T, Schmidt S, Brandt S, Frey D, Hannula H, Neuvonen T, Karhu J, Vajkoczy P, Suess O. Preoperative Functional Mapping for Rolandic Brain Tumor Surgery: Comparison of Navigated Transcranial Magnetic Stimulation to Direct Cortical Stimulation. Neurosurgery 2011; 69:581-8; discussion 588. [DOI: 10.1227/neu.0b013e3182181b89] [Citation(s) in RCA: 207] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Transcranial magnetic stimulation (TMS) is the only noninvasive method for presurgical stimulation mapping of cortical function. Recent technical advancements have significantly increased the focality and usability of the method.
OBJECTIVE:
To compare the accuracy of a 3-dimensional magnetic resonance imaging-navigated TMS system (nTMS) with the gold standard of direct cortical stimulation (DCS).
METHODS:
The primary motor areas of 20 patients with rolandic tumors were mapped preoperatively with nTMS at 110% of the individual resting motor threshold. Intraoperative DCS was available from 17 patients. The stimulus locations eliciting the largest electromyographic response in the target muscles (“hotspots”) were determined for both methods.
RESULTS:
The nTMS and DCS hotspots were located on the same gyrus in all cases. The mean ± SEM distance between the nTMS and DCS hotspots was 7.83 ± 1.18 mm for the abductor pollicis brevis (APB) muscle (n = 15) and 7.07 ± 0.88 mm for the tibialis anterior muscle (n = 8). When a low number of DCS stimulations was performed, the distance between the nTMS and DCS hotspots increased substantially (r = −0.86 for APB). After the exclusion of the cases with < 15 DCS APB responses, the mean ± SEM distance between the hotspots was only 4.70 ± 1.09 mm for APB (n = 8).
CONCLUSION:
Peritumoral mapping of the motor cortex by nTMS agreed well with the gold standard of DCS. Thus, nTMS is a reliable tool for preoperative mapping of motor function.
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Affiliation(s)
- Thomas Picht
- Departments of Neurosurgery, Charité-Universitaetsmedizin, Berlin, Germany
| | - Sein Schmidt
- Departments of Neurology, Charité-Universitaetsmedizin, Berlin, Germany
| | - Stephan Brandt
- Departments of Neurology, Charité-Universitaetsmedizin, Berlin, Germany
| | - Dietmar Frey
- Departments of Neurosurgery, Charité-Universitaetsmedizin, Berlin, Germany
| | - Henri Hannula
- Nexstim Ltd, Helsinki, Finland
- Neuroscience Unit, Institute of Biomedicine/Physiology University of Helsinki, Helsinki, Finland
| | - Tuomas Neuvonen
- Nexstim Ltd, Helsinki, Finland
- Neuroscience Unit, Institute of Biomedicine/Physiology University of Helsinki, Helsinki, Finland
| | - Jari Karhu
- Nexstim Ltd, Helsinki, Finland
- Department of Physiology University of Eastern Finland, Kuopio, Finland
| | - Peter Vajkoczy
- Departments of Neurosurgery, Charité-Universitaetsmedizin, Berlin, Germany
| | - Olaf Suess
- Departments of Neurosurgery, Charité-Universitaetsmedizin, Berlin, Germany
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