Registration and real-time visualization of transcranial magnetic stimulation with 3-D MR images

Accuracy and precision of navigated transcranial magnetic stimulation

Objective.Transcranial magnetic stimulation (TMS) induces an electric field (E-field) in the cortex. To facilitate stimulation targeting, image-guided neuronavigation systems have been introduced. Such systems track the placement of the coil with respect to the head and visualize the estimated cortical stimulation location on an anatomical brain image in real time. The accuracy and precision of the neuronavigation is affected by multiple factors. Our aim was to analyze how different factors in TMS neuronavigation affect the accuracy and precision of the coil-head coregistration and the estimated E-field.Approach.By performing simulations, we estimated navigation errors due to distortions in magnetic resonance images (MRIs), head-to-MRI registration (landmark- and surface-based registrations), localization and movement of the head tracker, and localization of the coil tracker. We analyzed the effect of these errors on coil and head coregistration and on the induced E-field as determined with simplistic and realistic head models.Main results.Average total coregistration accuracies were in the range of 2.2-3.6 mm and 1°; precision values were about half of the accuracy values. The coregistration errors were mainly due to head-to-MRI registration with average accuracies 1.5-1.9 mm/0.2-0.4° and precisions 0.5-0.8 mm/0.1-0.2° better with surface-based registration. The other major source of error was the movement of the head tracker with average accuracy of 1.5 mm and precision of 1.1 mm. When assessed within an E-field method, the average accuracies of the peak E-field location, orientation, and magnitude ranged between 1.5 and 5.0 mm, 0.9 and 4.8°, and 4.4 and 8.5% across the E-field models studied. The largest errors were obtained with the landmark-based registration. When computing another accuracy measure with the most realistic E-field model as a reference, the accuracies tended to improve from about 10 mm/15°/25% to about 2 mm/2°/5% when increasing realism of the E-field model.Significance.The results of this comprehensive analysis help TMS operators to recognize the main sources of error in TMS navigation and that the coregistration errors and their effect in the E-field estimation depend on the methods applied. To ensure reliable TMS navigation, we recommend surface-based head-to-MRI registration and realistic models for E-field computations.

Real-Time Artifacts Reduction during TMS-EEG Co-Registration: A Comprehensive Review on Technologies and Procedures

Transcranial magnetic stimulation (TMS) excites neurons in the cortex, and neural activity can be simultaneously recorded using electroencephalography (EEG). However, TMS-evoked EEG potentials (TEPs) do not only reflect transcranial neural stimulation as they can be contaminated by artifacts. Over the last two decades, significant developments in EEG amplifiers, TMS-compatible technology, customized hardware and open source software have enabled researchers to develop approaches which can substantially reduce TMS-induced artifacts. In TMS-EEG experiments, various physiological and external occurrences have been identified and attempts have been made to minimize or remove them using online techniques. Despite these advances, technological issues and methodological constraints prevent straightforward recordings of early TEPs components. To the best of our knowledge, there is no review on both TMS-EEG artifacts and EEG technologies in the literature to-date. Our survey aims to provide an overview of research studies in this field over the last 40 years. We review TMS-EEG artifacts, their sources and their waveforms and present the state-of-the-art in EEG technologies and front-end characteristics. We also propose a synchronization toolbox for TMS-EEG laboratories. We then review subject preparation frameworks and online artifacts reduction maneuvers for improving data acquisition and conclude by outlining open challenges and future research directions in the field.

Individualized Template MRI Is a Valid and Reliable Alternative to Individual MRI for Spatial Tracking in Navigated TMS Studies in Healthy Subjects

Objectives: Navigated transcranial magnetic stimulation (nTMS) provides significant benefits over classic TMS. Yet, the acquisition of individual structural magnetic resonance images (MRI_individual) is a time-consuming, expensive, and not feasible prerequisite in all subjects for spatial tracking and anatomical guidance in nTMS studies. We hypothesize that spatial transformation can be used to adjust MRI templates to individual head shapes (MRI_warped) and that TMS parameters do not differ between nTMS using MRI_individual or MRI_warped.

Materials and Methods: Twenty identical TMS sessions, each including four different navigation conditions, were conducted in 10 healthy subjects (one female, 27.4 ± 3.8 years), i.e., twice per subject by two researchers to additionally assess interrater reliabilities. MRI_individual were acquired for all subjects. MRI_warped were obtained through the spatial transformation of a template MRI following a 5-, 9-and 36-point head surface registration (MRI_{warped_5}, MRI_{warped_9}, MRI_{warped_36}). Stimulation hotspot locations, resting motor threshold (RMT), 500 μV motor threshold (500 μV-MT), and mean absolute motor evoked potential difference (MAD) of primary motor cortex (M1) examinations were compared between nTMS using either MRI_warped variants or MRI_individual and non-navigated TMS.

Results: M1 hotspots were spatially consistent between MRI_individual and MRI_{warped_36} (insignificant deviation by 4.79 ± 2.62 mm). MEP thresholds and variance were also equivalent between MRI_individual and MRI_{warped_36} with mean differences of RMT by −0.05 ± 2.28% maximum stimulator output (%MSO; t₍₁₉₎ = −0.09, p = 0.923), 500 μV-MT by −0.15 ± 1.63%MSO (t₍₁₉₎ = −0.41, p = 0.686) and MAD by 70.5 ± 214.38 μV (t₍₁₉₎ = 1.47, p = 0.158). Intraclass correlations (ICC) of motor thresholds were between 0.88 and 0.97.

Conclusions: NTMS examinations of M1 yield equivalent topographical and functional results using MRI_individual and MRI_warped if a sufficient number of registration points are used.

Proposal for an accurate TMS-MRI co-registration process via 3D laser scanning

An important technical issue in transcranial magnetic stimulation (TMS) usage is how accurately the specific brain areas activated by TMS are assessed. However, in practice, electric field induced in TMS is dispersed and therefore actual estimation is still difficult. As a preliminary step, the projection line which is perpendicular to the TMS stimulation coil beneath the center of the coil must be accurately estimated into the brain. Therefore, we have developed a new TMS-MRI co-registration procedure that employs a 3D laser-scanner system that is very useful for general hand-manipulated TMS, and which easily estimates the TMS projection point onto the brain. The proposed system accurately captures the positional relationship between the TMS coil and anatomical images. The results of 3D image processing revealed that the registration error at each stage was kept within the submillimeter level. In addition, a motor evoked potential experiment examining the right finger motor area revealed that understandable responses were obtained when stimulation was targeted to the three different motor areas according to Penfield's map. 3D laser scanning is a technique of substantial recent interest for anatomical co-registration. The proposed method demonstrated submillimeter level accuracy of TMS-MRI co-registration.

The left supramarginal gyrus contributes to finger positioning for object use: a neuronavigated transcranial magnetic stimulation study

In everyday actions, we grasp dozens of different manipulable objects in ways that accommodate their functional use. Neuroimaging studies showed that grasping objects in a way that is appropriate for their use involves a left-lateralized network including the supramarginal gyrus (SMG), the anterior intraparietal area (AIP) and the ventral premotor cortex (PMv). However, because previous works premised their conclusions on tasks requiring action execution, it has remained difficult to discriminate between the areas involved in specifying the position of fingers onto the object from those implementing the motor programme required to perform the action. To address this issue, we asked healthy participants to make judgements about pictures of manipulable objects, while repetitive transcranial magnetic stimulation (rTMS) was applied over the left SMG, AIP, PMv or, as a control, the vertex. The participants were asked to name the part of the image where the thumb or the index finger was expected to contact the object during its normal utilization or where a given attribute of the same object was located. The two tasks were strictly identical in terms of visual display, working memory demands and response requirements. Results showed that rTMS over SMG slowed down judgements of finger positions but not judgements of object attributes. Both types of judgements remained unaffected when rTMS was applied over AIP or PMv. This finding demonstrates that, within the parieto-frontal network dedicated to object use, at least the left SMG is involved in specifying the appropriate position of the thumb and index onto the object.

Disruption of Broca's Area Alters Higher-order Chunking Processing during Perceptual Sequence Learning

Because Broca's area is known to be involved in many cognitive functions, including language, music, and action processing, several attempts have been made to propose a unifying theory of its role that emphasizes a possible contribution to syntactic processing. Recently, we have postulated that Broca's area might be involved in higher-order chunk processing during implicit learning of a motor sequence. Chunking is an information-processing mechanism that consists of grouping consecutive items in a sequence and is likely to be involved in all of the aforementioned cognitive processes. Demonstrating a contribution of Broca's area to chunking during the learning of a nonmotor sequence that does not involve language could shed new light on its function. To address this issue, we used offline MRI-guided TMS in healthy volunteers to disrupt the activity of either the posterior part of Broca's area (left Brodmann's area [BA] 44) or a control site just before participants learned a perceptual sequence structured in distinct hierarchical levels. We found that disruption of the left BA 44 increased the processing time of stimuli representing the boundaries of higher-order chunks and modified the chunking strategy. The current results highlight the possible role of the left BA 44 in building up effector-independent representations of higher-order events in structured sequences. This might clarify the contribution of Broca's area in processing hierarchical structures, a key mechanism in many cognitive functions, such as language and composite actions.

Capturing neuroplastic changes after bimanual intensive rehabilitation in children with unilateral spastic cerebral palsy: A combined DTI, TMS and fMRI pilot study

Intensive rehabilitation interventions have been shown to be efficacious in improving upper extremity function in children with unilateral spastic cerebral palsy (USCP). These interventions are based on motor learning principles and engage children in skillful movements. Improvements in upper extremity function are believed to be associated with neuroplastic changes. However, these neuroplastic changes have not been well-described in children with cerebral palsy, likely due to challenges in defining and implementing the optimal tools and tests in children. Here we documented the implementation of three different neurological assessments (diffusion tensor imaging-DTI, transcranial magnetic stimulation-TMS and functional magnetic resonance imaging-fMRI) before and after a bimanual intensive treatment (HABIT-ILE) in two children with USCP presenting differential corticospinal developmental reorganization (ipsilateral and contralateral). The aim of the study was to capture neurophysiological changes and to document the complementary relationship between these measures, the potential measurable changes and the feasibility of applying these techniques in children with USCP. Independent of cortical reorganization, both children showed increases in activation and size of the motor areas controlling the affected hand, quantified with different techniques. In addition, fMRI provided additional unexpected changes in the reward circuit while using the affected hand.

Primary Motor Cortex Representation of Handgrip Muscles in Patients with Leprosy

BACKGROUND

Leprosy is an endemic infectious disease caused by Mycobacterium leprae that predominantly attacks the skin and peripheral nerves, leading to progressive impairment of motor, sensory and autonomic function. Little is known about how this peripheral neuropathy affects corticospinal excitability of handgrip muscles. Our purpose was to explore the motor cortex organization after progressive peripheral nerve injury and upper-limb dysfunction induced by leprosy using noninvasive transcranial magnetic stimulation (TMS).

METHODS

In a cross-sectional study design, we mapped bilaterally in the primary motor cortex (M1) the representations of the hand flexor digitorum superficialis (FDS), as well as of the intrinsic hand muscles abductor pollicis brevis (APB), first dorsal interosseous (FDI) and abductor digiti minimi (ADM). All participants underwent clinical assessment, handgrip dynamometry and motor and sensory nerve conduction exams 30 days before mapping. Wilcoxon signed rank and Mann-Whitney tests were performed with an alpha-value of p<0.05.

FINDINGS

Dynamometry performance of the patients' most affected hand (MAH), was worse than that of the less affected hand (LAH) and of healthy controls participants (p = 0.031), confirming handgrip impairment. Motor threshold (MT) of the FDS muscle was higher in both hemispheres in patients as compared to controls, and lower in the hemisphere contralateral to the MAH when compared to that of the LAH. Moreover, motor evoked potential (MEP) amplitudes collected in the FDS of the MAH were higher in comparison to those of controls. Strikingly, MEPs in the intrinsic hand muscle FDI had lower amplitudes in the hemisphere contralateral to MAH as compared to those of the LAH and the control group. Taken together, these results are suggestive of a more robust representation of an extrinsic hand flexor and impaired intrinsic hand muscle function in the hemisphere contralateral to the MAH due to leprosy.

CONCLUSION

Decreased sensory-motor function induced by leprosy affects handgrip muscle representation in M1.

Dissociable contribution of the parietal and frontal cortex to coding movement direction and amplitude

To reach for an object, we must convert its spatial location into an appropriate motor command, merging movement direction and amplitude. In humans, it has been suggested that this visuo-motor transformation occurs in a dorsomedial parieto-frontal pathway, although the causal contribution of the areas constituting the “reaching circuit” remains unknown. Here we used transcranial magnetic stimulation (TMS) in healthy volunteers to disrupt the function of either the medial intraparietal area (mIPS) or dorsal premotor cortex (PMd), in each hemisphere. The task consisted in performing step-tracking movements with the right wrist towards targets located in different directions and eccentricities; targets were either visible for the whole trial (Target-ON) or flashed for 200 ms (Target-OFF). Left and right mIPS disruption led to errors in the initial direction of movements performed towards contralateral targets. These errors were corrected online in the Target-ON condition but when the target was flashed for 200 ms, mIPS TMS manifested as a larger endpoint spreading. In contrast, left PMd virtual lesions led to higher acceleration and velocity peaks—two parameters typically used to probe the planned movement amplitude—irrespective of the target position, hemifield and presentation condition; in the Target-OFF condition, left PMd TMS induced overshooting and increased the endpoint dispersion along the axis of the target direction. These results indicate that left PMd intervenes in coding amplitude during movement preparation. The critical TMS timings leading to errors in direction and amplitude were different, namely 160–100 ms before movement onset for mIPS and 100–40 ms for left PMd. TMS applied over right PMd had no significant effect. These results demonstrate that, during motor preparation, direction and amplitude of goal-directed movements are processed by different cortical areas, at distinct timings, and according to a specific hemispheric organization.

The role of left supplementary motor area in grip force scaling

Skilled tool use and object manipulation critically relies on the ability to scale anticipatorily the grip force (GF) in relation to object dynamics. This predictive behaviour entails that the nervous system is able to store, and then select, the appropriate internal representation of common object dynamics, allowing GF to be applied in parallel with the arm motor commands. Although psychophysical studies have provided strong evidence supporting the existence of internal representations of object dynamics, known as “internal models”, their neural correlates are still debated. Because functional neuroimaging studies have repeatedly designated the supplementary motor area (SMA) as a possible candidate involved in internal model implementation, we used repetitive transcranial magnetic stimulation (rTMS) to interfere with the normal functioning of left or right SMA in healthy participants performing a grip-lift task with either hand. TMS applied over the left, but not right, SMA yielded an increase in both GF and GF rate, irrespective of the hand used to perform the task, and only when TMS was delivered 130–180 ms before the fingers contacted the object. We also found that both left and right SMA rTMS led to a decrease in preload phase durations for contralateral hand movements. The present study suggests that left SMA is a crucial node in the network processing the internal representation of object dynamics although further experiments are required to rule out that TMS does not affect the GF gain. The present finding also further substantiates the left hemisphere dominance in scaling GF.

Top-down inhibitory control exerted by the medial frontal cortex during action selection under conflict

Top-down control is critical to select goal-directed actions in changeable environments, particularly when several conflicting options compete for selection. In humans, this control system is thought to involve an inhibitory mechanism that suppresses the motor representation of unwanted responses to favor selection of the most appropriate action. Here, we aimed to evaluate the role of a region of the medial frontal cortex, the pre-SMA, in this form of inhibition by using a double coil TMS protocol combining repetitive TMS (rTMS) over the pre-SMA and a single-pulse TMS over the primary motor cortex (M1) during a visuomotor task that required participants to choose between a left or right button press according to an imperative cue. M1 stimulation allowed us to assess changes in motor excitability related to selected and nonselected (unwanted) actions, and rTMS was used to produce transient disruption of pre-SMA functioning. We found that when rTMS was applied over pre-SMA, inhibition of the nonselected movement representation was reduced. Importantly, this effect was only observed when the imperative cue produced a substantial amount of competition between the response alternatives. These results are consistent with previous studies pointing to a role of pre-SMA in competition resolution. In addition, our findings indicate that this function of pre-SMA involves the control of inhibitory influences directed at unwanted action representations.

Theta burst stimulation applied over primary motor and somatosensory cortices produces analgesia unrelated to the changes in nociceptive event-related potentials

Continuous theta burst stimulation (cTBS) applied over the primary motor cortex (M1) can alleviate pain although the neural basis of this effect remains largely unknown. Besides, the primary somatosensory cortex (S1) is thought to play a pivotal role in the sensori-discriminative aspects of pain perception but the analgesic effect of cTBS applied over S1 remains controversial. To investigate cTBS-induced analgesia we characterized, in two separate experiments, the effect of cTBS applied either over M1 or S1 on the event-related brain potentials (ERPs) and perception elicited by nociceptive (CO2 laser stimulation) and non-nociceptive (transcutaneous electrical stimulation) somatosensory stimuli. All stimuli were delivered to the ipsilateral and contralateral hand. We found that both cTBS applied over M1 and cTBS applied over S1 significantly reduced the percept elicited by nociceptive stimuli delivered to the contralateral hand as compared to similar stimulation of the ipsilateral hand. In contrast, cTBS did not modulate the perception of non-nociceptive stimuli. Surprisingly, this side-dependent analgesic effect of cTBS was not reflected in the amplitude modulation of nociceptive ERPs. Indeed, both nociceptive (N160, N240 and P360 waves) and late-latency non-nociceptive (N140 and P200 waves) ERPs elicited by stimulation of the contralateral and ipsilateral hands were similarly reduced after cTBS, suggesting an unspecific effect, possibly due to habituation or reduced alertness. In conclusion, cTBS applied over M1 and S1 reduces similarly the perception of nociceptive inputs originating from the contralateral hand, but this analgesic effect is not reflected in the magnitude of nociceptive ERPs.

Deficit in complex sequence processing after a virtual lesion of left BA45

Although the contribution of Broca's area to motor cognition is generally accepted, its exact role remains controversial. A previous functional imaging study has suggested that Broca's area implements hierarchically organised motor behaviours and, in particular, that its anterior (Brodmann area 45, BA45) and posterior (BA44) parts process, respectively, higher and lower-level hierarchical elements. This function of Broca's area could generalize to other cognitive functions, including language. However, because of the correlative nature of functional imaging data, the causal relationship between Broca's region activation and its behavioural significance cannot be ascertained. To circumvent this limitation, we used on-line repetitive transcranial magnetic stimulation to disrupt neuronal processing in left BA45, left BA44 or left dorsal premotor cortex, three areas that have been shown to exhibit a phasic activation when participants performed hierarchically organised motor behaviours. The experiment was conducted in healthy volunteers performing the same two key-press sequences as those used in a previous imaging study, and which differed in terms of hierarchical organisation. The performance of the lower-order hierarchical task (Experiment #1) was unaffected by magnetic stimulation. In contrast, in the higher-order hierarchical task (Experiment #2, “superordinate” task), we found that a virtual lesion of the anterior part of Broca's area (left BA45) delayed the processing of the cue initiating the sequence in an effector-independent way. Interestingly, in this task, the initiation cue only informed the subjects about the rules to be applied to produce the appropriate response but did not allow them to anticipate the entire motor sequence. A second important finding was a RT decrease following left PMd virtual lesions in the superordinate task, a result compatible with the view that PMd plays a critical role in impulse control. The present study therefore demonstrates the role of left BA45 in planning the higher-order hierarchical levels of motor sequences.

Accuracy of an individualized MR-based head model for navigated brain stimulation

In the search for a less expensive alternative to magnetic resonance imaging (MRI), which is contraindicated in some patients, we evaluated the accuracy of an individualized MR template-based head model in terms of navigated brain stimulation system targeting. The mean error between the identification of target points on individualized and individual (gold standard) head models was found to be 4.69±2.21 mm (arithmetic mean), i.e., more comparable to the values reported for individual MRI-based than for MR-independent approaches.

Prefrontal rTMS for treating depression: location and intensity results from the OPT-TMS multi-site clinical trial

BACKGROUND

Motor cortex localization and motor threshold determination often guide Transcranial Magnetic Stimulation (TMS) placement and intensity settings for non-motor brain stimulation. However, anatomic variability results in variability of placement and effective intensity.

OBJECTIVE

Post-study analysis of the OPT-TMS Study reviewed both the final positioning and the effective intensity of stimulation (accounting for relative prefrontal scalp-cortex distances).

METHODS

We acquired MRI scans of 185 patients in a multi-site trial of left prefrontal TMS for depression. Scans had marked motor sites (localized with TMS) and marked prefrontal sites (5 cm anterior of motor cortex by the "5 cm rule"). Based on a visual determination made before the first treatment, TMS therapy occurred either at the 5 cm location or was adjusted 1 cm forward. Stimulation intensity was 120% of resting motor threshold.

RESULTS

The "5 cm rule" would have placed stimulation in premotor cortex for 9% of patients, which was reduced to 4% with adjustments. We did not find a statistically significant effect of positioning on remission, but no patients with premotor stimulation achieved remission (0/7). Effective stimulation ranged from 93 to 156% of motor threshold, and no seizures were induced across this range. Patients experienced remission with effective stimulation intensity ranging from 93 to 146% of motor threshold, and we did not find a significant effect of effective intensity on remission.

CONCLUSIONS

Our data indicates that individualized positioning methods are useful to reduce variability in placement. Stimulation at 120% of motor threshold, unadjusted for scalp-cortex distances, appears safe for a broad range of patients.

Role of Broca's area in motor sequence programming: a cTBS study

Besides language, the contribution of Broca's area to motor cognition is now widely accepted. In this study, we investigated the role of its posterior part (left Brodmann area 44) in learning of a motor sequence by altering its functioning with a continuous theta-burst transcranial magnetic stimulation (cTBS) in 12 healthy participants before they learned the sequence by observation. Twelve control individuals underwent the same experiment with cTBS applied over the vertex. Although cTBS over Brodmann area 44 did not impair sequence learning, it significantly increased the response latency as measured during the retention test, performed 24 h later. This finding suggests that Broca's area might be critically involved in organizing, and/or storing, the individual components of a motor sequence before its execution.

Dissociating the role of prefrontal and premotor cortices in controlling inhibitory mechanisms during motor preparation

Top-down control processes are critical to select goal-directed actions in flexible environments. In humans, these processes include two inhibitory mechanisms that operate during response selection: one is involved in solving a competition between different response options, the other ensures that a selected response is initiated in a timely manner. Here, we evaluated the role of dorsal premotor cortex (PMd) and lateral prefrontal cortex (LPF) of healthy subjects in these two forms of inhibition by using an innovative transcranial magnetic stimulation (TMS) protocol combining repetitive TMS (rTMS) over PMd or LPF and a single pulse TMS (sTMS) over primary motor cortex (M1). sTMS over M1 allowed us to assess inhibitory changes in corticospinal excitability, while rTMS was used to produce transient disruption of PMd or LPF. We found that rTMS over LPF reduces inhibition associated with competition resolution, whereas rTMS over PMd decreases inhibition associated with response impulse control. These results emphasize the dissociable contributions of these two frontal regions to inhibitory control during motor preparation. The association of LPF with competition resolution is consistent with the role of this area in relatively abstract aspects of control related to goal maintenance, ensuring that the appropriate response is selected in a variable context. In contrast, the association of PMd with impulse control is consistent with the role of this area in more specific processes related to motor preparation and initiation.

Role of the medial part of the intraparietal sulcus in implementing movement direction

The contribution of the posterior parietal cortex (PPC) to visually guided movements has been originally inferred from observations made in patients suffering from optic ataxia. Subsequent electrophysiological studies in monkeys and functional imaging data in humans have corroborated the key role played by the PPC in sensorimotor transformations underlying goal-directed movements, although the exact contribution of this structure remains debated. Here, we used transcranial magnetic stimulation (TMS) to interfere transiently with the function of the left or right medial part of the intraparietal sulcus (mIPS) in healthy volunteers performing visually guided movements with the right hand. We found that a "virtual lesion" of either mIPS increased the scattering in initial movement direction (DIR), leading to longer trajectory and prolonged movement time, but only when TMS was delivered 100-160 ms before movement onset and for movements directed toward contralateral targets. Control experiments showed that deficits in DIR consequent to mIPS virtual lesions resulted from an inappropriate implementation of the motor command underlying the forthcoming movement and not from an inaccurate computation of the target localization. The present study indicates that mIPS plays a causal role in implementing specifically the direction vector of visually guided movements toward objects situated in the contralateral hemifield.

Role of Broca's area in implicit motor skill learning: evidence from continuous theta-burst magnetic stimulation

Complex actions can be regarded as a concatenation of simple motor acts, arranged according to specific rules. Because the caudal part of the Broca's region (left Brodmann's area 44, BA 44) is involved in processing hierarchically organized behaviors, we aimed to test the hypothesis that this area may also play a role in learning structured motor sequences. To address this issue, we investigated the inhibitory effects of a continuous theta-burst TMS (cTBS) applied over left BA 44 in healthy subjects, just before they performed a serial RT task (SRTT). SRTT has been widely used to study motor skill learning and is also of interest because, for complex structured sequences, subjects spontaneously organize them into smaller subsequences, referred to as chunks. As a control, cTBS was applied over the vertex in another group, which underwent the same experiment. Control subjects showed both a general practice learning effect, evidenced by a progressive decrease in RT across blocks and a sequence-specific learning effect, demonstrated by a significant RT increase in a pseudorandom sequence. In contrast, when cTBS was applied over left BA 44, subjects lacked both the general practice and sequence-specific learning effects. However, surprisingly, their chunking pattern was preserved and remained indistinguishable from controls. The present study indicates that left BA 44 plays a role in motor sequence learning, but without being involved in elementary chunking. This dissociation between chunking and sequence learning could be explained if we postulate that left BA 44 intervenes in high hierarchical level processing, possibly to integrate elementary chunks together.

Motor cortex representation of the upper-limb in individuals born without a hand

The body schema is an action-related representation of the body that arises from activity in a network of multiple brain areas. While it was initially thought that the body schema developed with experience, the existence of phantom limbs in individuals born without a limb (amelics) led to the suggestion that it was innate. The problem with this idea, however, is that the vast majority of amelics do not report the presence of a phantom limb. Transcranial magnetic stimulation (TMS) applied over the primary motor cortex (M1) of traumatic amputees can evoke movement sensations in the phantom, suggesting that traumatic amputation does not delete movement representations of the missing hand. Given this, we asked whether the absence of a phantom limb in the majority of amelics means that the motor cortex does not contain a cortical representation of the missing limb, or whether it is present but has been deactivated by the lack of sensorimotor experience. In four upper-limb amelic subjects we directly stimulated the arm/hand region of M1 to see 1) whether we could evoke phantom sensations, and 2) whether muscle representations in the two cortices were organised asymmetrically. TMS applied over the motor cortex contralateral to the missing limb evoked contractions in stump muscles but did not evoke phantom movement sensations. The location and extent of muscle maps varied between hemispheres but did not reveal any systematic asymmetries. In contrast, forearm muscle thresholds were always higher for the missing limb side. We suggest that phantom movement sensations reported by some upper limb amelics are mostly driven by vision and not by the persistence of motor commands to the missing limb within the sensorimotor cortex. We propose that prewired movement representations of a limb need the experience of movement to be expressed within the primary motor cortex.

Dissociation between manipulation and conceptual knowledge of object use in the supramarginalis gyrus

Because tool naming activates motor-related areas in the posterior parietal cortex, it has been suggested that conceptual knowledge of tools relies on their unique manipulation patterns. However, this view is questioned by the finding that some patients impaired in retrieving manipulation knowledge of man-made objects are still able to perform conceptual judgments on them. To address this issue, we used repetitive transcranial magnetic stimulation (rTMS) to interfere with the functioning of the anterior part of the right or left supramarginalis gyrus (SMG), a region critically involved in object-directed actions. rTMS was delivered in healthy participants performing four judgment tasks designed to explore different aspects of manipulation and conceptual knowledge of man-made objects. The two manipulation judgment tasks consisted in determining whether (1) two objects displayed on a computer screen are normally used by adopting a comparable hand posture, or (2) a given hand posture is appropriate to use an object. In the two conceptual judgment tasks, subjects had to decide whether (1) two objects displayed on the computer screen are normally used in the same context or (2) they are functionally related. We found that virtual lesions of left SMG interfere only with the performance of the manipulation judgment task in which subjects had to decide whether two different objects are used by adopting the same hand posture, all the other tasks being unaltered. rTMS applied over the right SMG had no effect. These results challenge the assumption that conceptual knowledge of tools is grounded upon motor representations.

Neuronavigation increases the physiologic and behavioral effects of low-frequency rTMS of primary motor cortex in healthy subjects

Low-frequency repetitive transcranial magnetic stimulation (rTMS) can exert local and inter-hemispheric neuromodulatory effects on cortical excitability. These physiologic effects can translate into changes in motor behavior, and may offer valuable therapeutic interventions in recovery from stroke. Neuronavigated TMS can maximize accurate and consistent targeting of a given cortical region, but is a lot more involved that conventional TMS. We aimed to assess whether neuronavigation enhances the physiologic and behavioral effects of low-frequency rTMS. Ten healthy subjects underwent two experimental sessions during which they received 1600 pulses of either navigated or non-navigated 1 Hz rTMS at 90% of the resting motor threshold (RMT) intensity over the motor cortical representation for left first dorsal interosseous (FDI) muscle. We compared the effects of navigated and non-navigated rTMS on motor-evoked potentials (MEPs) to single-pulse TMS, intracortical inhibition (ICI) and intracortical facilitation (ICF) by paired-pulse TMS, and performance in various behavioral tasks (index finger tapping, simple reaction time and grip strength tasks). Following navigated rTMS, the amplitude of MEPs elicited from the contralateral (unstimulated) motor cortex was significantly increased, and was associated with an increase in ICF and a trend to decrease in ICI. In contrast, non-navigated rTMS elicited nonsignificant changes, most prominently ipsilateral to rTMS. Behaviorally, navigated rTMS significantly improved reaction time RT and pinch force with the hand ipsilateral to stimulation. Non-navigated rTMS lead to similar behavioral trends, although the effects did not reach significance. In summary, navigated rTMS leads to more robust modulation of the contralateral (unstimulated) hemisphere resulting in physiologic and behavioral effects. Our findings highlight the spatial specificity of inter-hemispheric TMS effects, illustrate the superiority of navigated rTMS for certain applications, and have implications for therapeutic applications of rTMS.

Contribution of the primary motor cortex to motor imagery: a subthreshold TMS study

Motor imagery (MI) mostly activates the same brain regions as movement execution (ME) including the primary motor cortex (Brodmann area 4, BA4). However, whether BA4 is functionally relevant for MI remains controversial. The finding that MI tasks are impaired by BA4 virtual lesions induced by transcranial magnetic stimulation (TMS) supports this view, though previous studies do not permit to exclude that BA4 is also involved in other processes such as hand recognition. Additionally, previous works largely underestimated the possible negative consequences of TMS-induced muscle twitches on MI task performance. Here we investigated the role of BA4 in MI by interfering with the function of the left or right BA4 in healthy subjects performing a MI task in which they had to make laterality judgements on rotated hand drawings. We used a subthreshold repetitive TMS protocol and monitored electromyographic activity to exclude undesirable effects of hand muscle twitches. We found that BA4 virtual lesions selectively increased reaction times in laterality judgments on hand drawings, leaving unaffected a task of equal difficulty, involving judgments on letters. Interestingly, the effects of virtual lesions of left and right BA4 on MI task performance were the same irrespective of the laterality (left/right) of hand drawings. A second experiment allowed us to rule out the possibility that BA4 lesions affect visual or semantic processing of hand drawings. Altogether, these results indicate that BA4 contribution to MI tasks is specifically related to the mental simulation process and further emphasize the functional coupling between ME and MI.

Role of distinct parietal areas in arithmetic: an fMRI-guided TMS study

Although several parietal areas are known to be involved in number processing, their possible role in arithmetic operations remains debated. It has been hypothesized that the horizontal segment of the intraparietal sulcus (hIPS) and the posterior superior parietal lobule (PSPL) contribute to operations solved by calculation procedures, such as subtraction, but whether these areas are also involved in operations solved by memory retrieval, such as multiplication, is controversial. In the present study, we first identified the parietal areas involved in subtraction and multiplication by means of functional magnetic resonance imaging (fMRI) and we found an increased activation, bilaterally, in the hIPS and PSPL during both arithmetic operations. In order to test whether these areas are causally involved in subtraction and multiplication, we used transcranial magnetic stimulation (TMS) to create, in each participant, a virtual lesion of either the hIPS or PSPL, over the sites corresponding to the peaks of activation gathered in fMRI. When compared to a control site, we found an increase in response latencies in both operations after a virtual lesion of either the left or right hIPS, but not of the PSPL. Moreover, TMS over the hIPS increased the error rate in the multiplication task. The present results indicate that even operations solved by memory retrieval, such as multiplication, rely on the hIPS. In contrast, the PSPL seems to underlie processes that are nonessential to solve basic subtraction and multiplication problems.

Monitoring coordination during bimanual movements: where is the mastermind?

One remarkable aspect of the human motor repertoire is the multitude of bimanual actions it contains. Still, the neural correlates of coordinated movements, in which the two hands share a common goal, remain debated. To address this issue, we designed two bimanual circling tasks that differed only in terms of goal conceptualization: a "coordination" task that required movements of both hands to adapt to each other to reach a common goal and an "independent" task that imposed a separate goal to each hand. fMRI allowed us to pinpoint three areas located in the right hemisphere that were more strongly activated in the coordination condition: the superior temporal gyrus (STG), the SMA, and the primary motor cortex (M1). We then used transcranial magnetic stimulation (TMS) to disrupt transiently the function of those three regions to determine their causal role in bimanual coordination. Right STG virtual lesions impaired bimanual coordination, whereas TMS to right M1 enhanced hand independence. TMS over SMA, left STG, or left M1 had no effect. The present study provides direct insight into the neural correlates of coordinated bimanual movements and highlights the role of right STG in such bimanual movements.

Salience representation in the parietal and frontal cortex

Some objects in the visual field are more likely to attract attention because they are either intrinsically eye catching or relevant in the context of a particular task. These two factors, known as stimulus-driven and goal-directed factors, respectively, are thought to be integrated into a unique salience map, possibly located in the frontal or the parietal cortex. However, the distinct contribution of these two regions to salience representation is difficult to establish experimentally and remains debated. In an attempt to address this issue, we designed several dual tasks composed of a letter reporting task and a visual search task, allowing us to quantify the salience of each visual item by measuring its probability to be selected by attention. In Experiment 1, the salience of the visual search items depended on a combination of conspicuity and relevance factors, whereas in Experiment 2, stimulus-driven and goal-directed factors were tested separately. Then, we used transcranial magnetic stimulation to interfere transiently with the function of the right angular gyrus (ANG) or right FEFs in healthy subjects performing these dual tasks. We found that interfering with the ANG and the FEF function specifically altered the influence of salience on the letter report rate without affecting the overall letter reporting rate, suggesting that these areas are involved in salience representation. In particular, the present study suggests that ANG is involved in goal-directed salience representation, whereas FEF would rather house a global salience map integrating both goal-directed and stimulus-driven factors.

Robot-assisted image-guided transcranial magnetic stimulation for somatotopic mapping of the motor cortex: a clinical pilot study

Purpose

Shape and exact location of motor cortical areas varies among individuals. The exact knowledge of these locations is crucial for planning of neurosurgical procedures. In this study, we have used robot-assisted image-guided transcranial magnetic stimulation (Ri-TMS) to elicit MEP response recorded for individual muscles and reconstruct functional motor maps of the primary motor cortex.

Methods

One healthy volunteer and five patients with intracranial tumors neighboring the precentral gyrus were selected for this pilot study. Conventional MRI and fMRI were obtained. Transcranial magnetic stimulation was performed using a MagPro X100 stimulator and a standard figure-of-eight coil positioned by an Adept Viper s850 robot. The fMRI activation/Ri-TMS response pattern were compared. In two cases, Ri-TMS was additionally compared to intraoperative direct electrical cortical stimulation.

Results

Maximal MEP response of the m. abductor digiti minimi was located in an area corresponding to the “hand knob” of the precentral gyrus for both hemispheres. Repeated Ri-TMS measurements showed a high reproducibility. Simultaneous registration of the MEP response for m. brachioradialis, m. abductor pollicis brevis, and m. abductor digiti minimi demonstrated individual peak areas of maximal MEP response for the individual muscle groups. Ri-TMS mapping was compared to the corresponding fMRI studies. The areas of maximal MEP response localized within the “finger tapping” activated areas by fMRI in all six individuals.

Conclusions

Ri-TMS is suitable for high resolution non-invasive preoperative somatotopic mapping of the motor cortex. Ri-TMS may help in the planning of neurosurgical procedures and may be directly used in navigation systems.

Role of Broca's area in encoding sequential human actions: a virtual lesion study

The exact contribution of Broca's area to motor cognition is still controversial. Here we used repetitive transcranial magnetic stimulation (5 Hz, five pulses) to interfere transiently with the function of left BA44 in 13 healthy individuals; the task consisted of reordering human actions or nonbiological events based on three pictures presented on a computer screen and extracted from a video showing the entire sequence beforehand. We found that a virtual lesion of left BA44 impairs individual performance only for biological actions, and more specifically for object-oriented syntactic actions. Our finding provides evidence that Broca's area plays a crucial role in encoding complex human movements, a process which may be crucial for understanding and/or programming actions.

TMS activation of interhemispheric pathways between the posterior parietal cortex and the contralateral motor cortex

Using a twin coil transcranial magnetic stimulation (tc-TMS) approach we have previously demonstrated that facilitation may be detected in the primary motor cortex (M1) following stimulation over the ipsilateral caudal intraparietal sulcus (cIPS). Here we tested the interhemispheric interactions between the IPS and the contralateral motor cortex (M1). We found that conditioning the right cIPS facilitated contralateral M1 when the conditioning stimulus had an intensity of 90% resting motor threshold (RMT) but not at 70% or 110% RMT. Facilitation was maximal when the interstimulus interval (ISI) between cIPS and M1 was 6 or 12 ms. These facilitatory effects were mediated by interactions with specific groups of interneurons in the contralateral M1. In fact, short intracortical inhibition (SICI) was reduced following cIPS stimulation. Moreover, additional comparison of facilitation of responses evoked by anterior-posterior versus posterior-anterior stimulation of M1 suggested that facilitation was more effective on early I1/I2 circuits than on I3 circuits. In contrast to these effects, stimulation of anterior IPS (aIPS) at 90% RMT induced inhibition, instead of facilitation, of contralateral M1 at ISIs of 10-12 ms. Finally, we found similar facilitation between left cIPS and right M1 although the conditioning stimuli had to have a higher intensity compared with stimulation of right cIPS (110% instead of 90% RMT). These findings demonstrate that different subregions of the posterior parietal cortex (PPC) in humans exert both facilitatory and inhibitory effects towards the contralateral primary motor cortex. These corticocortical projections could contribute to a variety of motor tasks such as bilateral manual coordination, movement planning in space and grasping.

Brain-mapping using robotized TMS

We present first results of brain-mapping using robotic Transcranial Magnetic Stimulation. This non-invasive procedure enables the reliable detection of the representation of individual muscles or muscle groups in the motor-cortex. The accuracy is only exceeded by direct electrical stimulation of the brain during surgery. Brain-mapping using robotic TMS can also be used to detect displacements of brain regions caused by tumors. The advantage of TMS is that it is non-invasive. In this study, we compare results from statistical mapping with robotic TMS to results achieved from direct stimulation done during tumor surgery. To our knowledge this is the first study of this type. We mapped the representation of three muscle groups (forearm, pinky and thumb) in tumor patients with the robot-aided TMS protocol and with direct stimulation. The resulting maps agree within 5mm.

Re-emergence of hand-muscle representations in human motor cortex after hand allograft

The human primary motor cortex (M1) undergoes considerable reorganization in response to traumatic upper limb amputation. The representations of the preserved arm muscles expand, invading portions of M1 previously dedicated to the hand, suggesting that former hand neurons are reassigned to the control of remaining proximal upper limb muscles. Hand allograft offers a unique opportunity to study the reversibility of such long-term cortical changes. We used transcranial magnetic stimulation in patient LB, who underwent bilateral hand transplantation 3 years after a traumatic amputation, to longitudinally track both the emergence of intrinsic (from the donor) hand muscles in M1 as well as changes in the representation of stump (upper arm and forearm) muscles. The same muscles were also mapped in patient CD, the first bilateral hand allograft recipient. Newly transplanted intrinsic muscles acquired a cortical representation in LB's M1 at 10 months postgraft for the left hand and at 26 months for the right hand. The appearance of a cortical representation of transplanted hand muscles in M1 coincided with the shrinkage of stump muscle representations for the left but not for the right side. In patient CD, transcranial magnetic stimulation performed at 51 months postgraft revealed a complete set of intrinsic hand-muscle representations for the left but not the right hand. Our findings show that newly transplanted muscles can be recognized and integrated into the patient's motor cortex.

Reorganisation of the right occipito-parietal stream for auditory spatial processing in early blind humans. A transcranial magnetic stimulation study

It is well known that, following an early visual deprivation, the neural network involved in processing auditory spatial information undergoes a profound reorganization. In particular, several studies have demonstrated an extensive activation of occipital brain areas, usually regarded as essentially "visual", when early blind subjects (EB) performed a task that requires spatial processing of sounds. However, little is known about the possible consequences of the activation of occipitals area on the function of the large cortical network known, in sighted subjects, to be involved in the processing of auditory spatial information. To address this issue, we used event-related transcranial magnetic stimulation (TMS) to induce virtual lesions of either the right intra-parietal sulcus (rIPS) or the right dorsal extrastriate occipital cortex (rOC) at different delays in EB subjects performing a sound lateralization task. Surprisingly, TMS applied over rIPS, a region critically involved in the spatial processing of sound in sighted subjects, had no influence on the task performance in EB. In contrast, TMS applied over rOC 50 ms after sound onset, disrupted the spatial processing of sounds originating from the contralateral hemifield. The present study shed new lights on the reorganisation of the cortical network dedicated to the spatial processing of sounds in EB by showing an early contribution of rOC and a lesser involvement of rIPS.

Reorganization of cortical hand representation in congenital hemiplegia

When damaged perinatally, as in congenital hemiplegia (CH), the corticospinal tract usually undergoes an extensive reorganization, such as the stabilization of normally transient projections to the ipsilateral spinal cord. Whether the reorganization of the corticospinal projections occurring in CH patients is also accompanied by a topographical rearrangement of the hand representations in the primary motor cortex (M1) remains unclear. To address this issue, we mapped, for both hands, the representation of the first dorsal interosseous muscle (1DI) in 12 CH patients by using transcranial magnetic stimulation co-registered onto individual three-dimensional magnetic resonance imaging; these maps were compared with those gathered in age-matched controls (n = 11). In the damaged hemisphere of CH patients, the representation of the paretic 1DI was either found in the hand knob of M1 (n = 5), shifted caudally (n = 5), or missing (n = 2). In the intact hemisphere of six CH patients, an additional, ipsilateral, representation of the paretic 1DI was found in the hand knob, where it overlapped exactly the representation of the non-paretic 1DI. In the other six CH patients, the ipsilateral representation of the paretic 1DI was either shifted caudally (n = 2) or was lacking (n = 4). Surprisingly, in these two subgroups of patients, the representation of the contralateral non-paretic 1DI was found in a more medio-dorsal position than in controls. The present study demonstrates that, besides the well-known reorganization of the corticospinal projections, early brain injuries may also lead to a topographical rearrangement of the representations of both the paretic and non-paretic hands in M1.

Double dissociation between motor and visual imagery in the posterior parietal cortex

Because motor imagery (MI) and visual imagery (VI) are influenced differently by factors such as biomechanical constraints or stimulus size, it is conceivable that they rely on separate processes, possibly involving distinct cortical networks, a view corroborated by neuroimaging and neuropsychological studies. In the posterior parietal cortex, it has been suggested that the superior parietal lobule (SPL) underlies VI, whereas MI relies on the supramarginalis gyrus (SMG). However, because several brain imaging studies have also shown an overlap of activations in SPL and SMG during VI or MI, the question arises as to which extent these 2 subregions really contribute to distinct imagery processes. To address this issue, we used repetitive transcranial magnetic stimulation to induce virtual lesions of either SMG or SPL in subjects performing a MI (hand drawing rotation) or a VI (letter rotation) task. Whatever hemisphere was stimulated, SMG lesions selectively altered MI, whereas SPL lesions only affected VI, demonstrating a double dissociation between MI and VI. Because these deficits were not influenced by the angular distance of the stimuli, we suggest that SMG and SPL are involved in the reenactment of the motor and visual representations, respectively, and not in mental rotation processes per se.

Validation of a method for coregistering scalp recording locations with 3D structural MR images

A common problem in brain imaging is how to most appropriately coregister anatomical and functional data sets into a common space. For surface-based recordings such as the event related optical signal (EROS), near-infrared spectroscopy (NIRS), event-related potentials (ERPs), and magnetoencephalography (MEG), alignment is typically done using either (1) a landmark-based method involving placement of surface markers that can be detected in both modalities; or (2) surface-fitting alignment that samples many points on the surface of the head in the functional space and aligns those points to the surface of the anatomical image. Here we compare these two approaches and advocate a combination of the two in order to optimize coregistration of EROS and NIRS data with structural magnetic resonance images (sMRI). Digitized 3D sensor locations obtained with a Polhemus digitizer can be effectively coregistered with sMRI using fiducial alignment as an initial guess followed by a Marquardt-Levenberg least-squares rigid-body transform (df = 6) to match the surfaces. Additional scaling parameters (df = 3) and point-by-point surface constraints can also be employed to further improve fitting. These alignment procedures place the lower-bound residual error at 1.3 +/- 0.1 mm (micro +/- s) and the upper-bound target registration error at 4.4 +/- 0.6 mm (micro +/- s). The dependence of such errors on scalp segmentation, number of registration points, and initial guess is also investigated. By optimizing alignment techniques, anatomical localization of surface recordings can be improved in individual subjects.

Time-course of posterior parietal and occipital cortex contribution to sound localization

It has been suggested that both the posterior parietal cortex (PPC) and the extrastriate occipital cortex (OC) participate in the spatial processing of sounds. However, the precise time-course of their contribution remains unknown, which is of particular interest, considering that it could give new insights into the mechanisms underlying auditory space perception. To address this issue, we have used event-related transcranial magnetic stimulation (TMS) to induce virtual lesions of either the right PPC or right OC at different delays in subjects performing a sound lateralization task. Our results confirmed that these two areas participate in the spatial processing of sounds. More precisely, we found that TMS applied over the right OC 50 msec after the stimulus onset significantly impaired the localization of sounds presented either to the right or to the left side. Moreover, right PPC virtual lesions induced 100 and 150 msec after sound presentation led to a rightward bias for stimuli delivered on the center and on the left side, reproducing transiently the deficits commonly observed in hemineglect patients. The finding that the right OC is involved in sound processing before the right PPC suggests that the OC exerts a feedforward influence on the PPC during auditory spatial processing.

Cortical topography of human first dorsal interroseus during individuated and nonindividuated grip tasks

Neural activity in the motor cortex and its descending projections is modulated in a task-related manner. Several TMS studies have shown that when normal human subjects execute different manual tasks requiring similar contraction levels in first dorsal interroseous (FDI) there is a task-related modulation of the amplitude of FDI motor evoked potentials (MEPs). Not all studies of task-related changes show the same pattern of results, however. One reason for this might be methodological. Studies have assessed task-related changes by stimulating a single site, which can provide information about task-related changes in the excitability of the cortex at that site, but which is not sensitive to excitability changes throughout the muscle's cortical representation. We investigated how the execution of an individuated versus a nonindividuated isometric grasping task affected the excitability of FDI's entire cortical representation. We examined FDI MEP amplitudes while subjects grasped an object between their thumb and index finger, or when they grasped the same object between their thumb and all four fingers, keeping the background level of EMG in FDI constant for the two tasks. We found no overall task-related change in the excitability of FDI or its cortical topography, possibly due to behavioral differences of individual subjects. The stability of FDI's cortical representation during two different manual tasks expands the possibilities for studying cortical reorganization in the context of active muscle contraction, which will enable us to better understand whether changes in the motor system observed when muscles are at rest are also present during voluntary muscle recruitment.

Selective modulation of interactions between ventral premotor cortex and primary motor cortex during precision grasping in humans

In humans, the rostral part of the ventral premotor cortex (PMv), the homologue of F5 in monkeys, is known to be critically involved in shaping the hand to grasp objects. How does information about hand posture, that is processed in PMv, give rise to appropriate motor commands for transmission to spinal circuits controlling the hand? Whereas PMv is crucial for skilled visuomotor control of the hand, PMv sends relatively few direct corticospinal projections to spinal segments innervating hand muscles and the most likely route for PMv to contribute to the control of hand shape is through cortico-cortical connections with primary motor cortex (M1). If this is the case, we predicted that PMv-M1 interactions should be modulated specifically during precision grasping in humans. To address this issue, we investigated PMv-M1 connections by means of paired-pulse transcranial magnetic stimulation (TMS) and compared whether they were differentially modulated at rest, and during precision versus power grip. To do so, TMS was applied over M1 either in isolation or after a conditioning stimulus delivered, at different delays, over the ipsilateral PMv. For the parameters of TMS tested, we found that, at rest, PMv exerted a net inhibitory influence on M1 whereas, during power grip, this inhibition disappeared and was converted into a net facilitation during precision grip. The finding that, in humans, PMv-M1 interactions are selectively modulated during specific types of grasp provides further evidence that these connections play an important role in control of the hand.

Transcranial magnetic stimulation and the challenge of coil placement: a comparison of conventional and stereotaxic neuronavigational strategies

The combination of transcranial magnetic stimulation (TMS) with functional neuroimaging has expanded the potential of TMS for human brain mapping. The precise and reliable positioning of the TMS coil is not a simple task, however. Modern frameless stereotaxic systems allow investigators to base navigation either on the subject's structural magnetic resonance imaging (MRI), functional MRI data, or the use of functional neuroimaging data from the literature, so-called "probabilistic approach." The latter assumes consistency across individuals in the location of task-related "activations" in standardized stereotaxic space. Conventional nonstereotaxic localization of brain areas is also a common method for defining the coil position. Our aim was to evaluate the accuracy of five different localization strategies in one single study. The left primary motor cortex (left M1-Hand) was used as target region. Three approaches were based on real-time frameless stereotaxy using information based on either anatomical or functional MRI. The remaining two strategies relied either on standard cranial landmarks (i.e., the International 10-20 EEG system) or a standardized function-guided procedure (i.e., the spatial relationship between the left and right M1-Hand). The results were compared to a TMS-based mapping of the primary motor cortex; center of gravity of motor-evoked potentials (MEP-CoG) was calculated for each subject (n = 10). Our findings suggest that highest precision can be achieved with fMRI-guided stimulation, which was accurate within the range of millimeters. Very consistent results were also obtained with the "probabilistic" approach. In view of these findings, we discuss the methods and special characteristics of each localization strategy.

EEG to MRI registration based on global and local similarities of MRI intensity distributions

In this paper, a novel method for EEG to MRI registration is proposed. Initial registration is achieved by extracting and matching symmetry planes of MRI and EEG data, followed by iterative registration based on minimizing a cost function. Comparison of the intensity distributions of the whole MR image and MRI voxels around a head surface point yields global similarities, while the comparison of intensity distributions of MRI voxels around corresponding EEG points, which reflects the head's sagittal symmetry, yields local similarities. Therefore, when the EEG points are registered to the MR image, maximal global and local similarities should be obtained. The cost function, incorporating global and local similarities, was the sum of Kullback-Leibler divergences between corresponding intensity distributions. The proposed method was evaluated on clinical MRI data with simulated EEG data, yielding mean registration error of 0.48 +/- 0.33 mm, while with real EEG data an average root-mean-square point-to-surface error of 2.27 +/- 0.02 mm was obtained.