Facilitation and disfacilitation of muscle responses after repetitive transcranial cortical stimulation and electrical peripheral nerve stimulation

Motor-evoked potentials are facilitated during perceptual identification of hand position in healthy subjects and stroke patients

OBJECTIVE

To delineate the facilitatory and/or inhibitory influence of relevant and irrelevant sensory afferent information to the motor cortex. The study is based on the assumption that sensorimotor coupling is crucial for motor learning and recovery.

DESIGN

The interaction of a standard transcranial magnetic stimulus (TMS) with the facilitatory and/or inhibitory influence that proprioceptive afferent information exerts on the motor cortex was investigated.

SETTING

A neurological rehabilitation hospital.

SUBJECTS

Sixteen healthy subjects and 14 stroke patients.

MAIN OUTCOME MEASURES

Amplitudes and latencies of motor-evoked potentials (MEPs) recorded from the extensor carpi radialis muscle. The influence of a sensory discrimination task was compared with the influence of a sensory input irrelevant for the task and to a verbal memory task. Recordings were taken after the hand had been moved passively in one of four different positions.

RESULTS

In the first trial, TMS was applied without any demand on the subjects. In the second trial, subjects were asked to identify the respective hand position and in the third trial a noun presented at a respective hand position had to be memorized and reproduced after TMS. The sensory discrimination task exerted by far the most prominent facilitatory effect on MEP amplitudes and latencies. An unspecific, albeit reproducible influence on MEP amplitudes was observed when a noun presented at a respective hand position had to be remembered.

CONCLUSIONS

Using a neurophysiological approach the study demonstrates that a sensory discrimination task based on relevant afferent information to motor centres of the brain forms a prominent facilitatory intervention for those muscle groups that are involved in the task. This holds true for healthy subjects and for hemiparetic stroke patients.

Subthreshold prefrontal repetitive transcranial magnetic stimulation reduces motor cortex excitability

The prefrontal cortex plays an important role in central motor control. We have examined whether prefrontal repetitive transcranial magnetic stimulation (rTMS) induces changes of motor cortex excitability determined by motor evoked potentials (MEPs) following single-pulse TMS. We studied 18 healthy volunteers stimulated at 5 Hz with 10% subthreshold prefrontal vs. occipital rTMS for 12 s. MEPs from the flexor carpi radialis muscle after single-pulse vertex stimulation were recorded during rTMS at 0, 4, 8, and 12 s. MEP areas decreased significantly after 8 s of prefrontal rTMS (P < 0. 05) but not after occipital rTMS. We conclude that rTMS of the prefrontal cortex may inhibit the primary motor areas.

Spatial facilitation of motor evoked responses in monitoring during spinal surgery

During spinal cord monitoring, motor responses in the tibialis anterior muscles were recorded on transcranial electrical stimulation of the motor cortex. In order to facilitate the responses, the cortical stimulus was preceded by a train of stimuli to the foot sole within the receptive field of the withdrawal reflex of the tibialis anterior muscle. This cutaneous input provides a spatial facilitation of the cortically elicited response. When the stimulus interval was 50-100 ms, large and reliable responses were seen in most cases.

Transcranial magnetic stimulation: its current role in epilepsy research

This paper reviews the current role of transcranial magnetic stimulation (TMS) in epilepsy research. After a brief introduction to the technical principles, the physiology and the safety aspects of TMS, emphasis is put on how human cortex excitability can be assessed by TMS and how this may improve our understanding of pathophysiological mechanisms in epilepsy and the mode of action of antiepileptic drugs (AEDs). Also, potential therapeutical applications of TMS are reviewed. For all aspects of this paper, a clear distinction was made between single-/paired-pulse TMS and repetitive TMS, since these two techniques have fundamentally different scopes and applications.