Interhemispheric facilitation of the hand motor area in humans

Subcallosal cingulate deep brain stimulation evokes two distinct cortical responses via differential white matter activation

Subcallosal cingulate (SCC) deep brain stimulation (DBS) is an emerging therapy for refractory depression. Good clinical outcomes are associated with the activation of white matter adjacent to the SCC. This activation produces a signature cortical evoked potential (EP), but it is unclear which of the many pathways in the vicinity of SCC is responsible for driving this response. Individualized biophysical models were built to achieve selective engagement of two target bundles: either the forceps minor (FM) or cingulum bundle (CB). Unilateral 2 Hz stimulation was performed in seven patients with treatment-resistant depression who responded to SCC DBS, and EPs were recorded using 256-sensor scalp electroencephalography. Two distinct EPs were observed: a 120 ms symmetric response spanning both hemispheres and a 60 ms asymmetrical EP. Activation of FM correlated with the symmetrical EPs, while activation of CB was correlated with the asymmetrical EPs. These results support prior model predictions that these two pathways are predominantly activated by clinical SCC DBS and provide first evidence of a link between cortical EPs and selective fiber bundle activation.

Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee

The review provides a comprehensive update (previous report: Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008;119(3):504-32) on clinical diagnostic utility of transcranial magnetic stimulation (TMS) in neurological diseases. Most TMS measures rely on stimulation of motor cortex and recording of motor evoked potentials. Paired-pulse TMS techniques, incorporating conventional amplitude-based and threshold tracking, have established clinical utility in neurodegenerative, movement, episodic (epilepsy, migraines), chronic pain and functional diseases. Cortical hyperexcitability has emerged as a diagnostic aid in amyotrophic lateral sclerosis. Single-pulse TMS measures are of utility in stroke, and myelopathy even in the absence of radiological changes. Short-latency afferent inhibition, related to central cholinergic transmission, is reduced in Alzheimer's disease. The triple stimulation technique (TST) may enhance diagnostic utility of conventional TMS measures to detect upper motor neuron involvement. The recording of motor evoked potentials can be used to perform functional mapping of the motor cortex or in preoperative assessment of eloquent brain regions before surgical resection of brain tumors. TMS exhibits utility in assessing lumbosacral/cervical nerve root function, especially in demyelinating neuropathies, and may be of utility in localizing the site of facial nerve palsies. TMS measures also have high sensitivity in detecting subclinical corticospinal lesions in multiple sclerosis. Abnormalities in central motor conduction time or TST correlate with motor impairment and disability in MS. Cerebellar stimulation may detect lesions in the cerebellum or cerebello-dentato-thalamo-motor cortical pathways. Combining TMS with electroencephalography, provides a novel method to measure parameters altered in neurological disorders, including cortical excitability, effective connectivity, and response complexity.

Induction of interhemispheric facilitation by short bursts of transcranial alternating current stimulation

Interhemispheric facilitation (IHF) describes potentiation of motor-evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) over primary motor cortex (M1), when they are preceded (3-6 ms) by conditioning TMS below motor threshold (MT) delivered over the opposite M1. This effect is however obtained only when the conditioning stimulation is sufficiently circumscribed. In paired associative protocols, (500 ms) bursts of 140 Hz transcranial alternating current stimulation (tACS) interact with the state of neural circuits in the opposite hemisphere in a similar manner to sub-threshold TMS. We hypothesised that tACS applied over M1 would elevate the amplitudes of MEPs elicited by suprathreshold TMS applied 6 ms later over the opposite M1. Thirty healthy right-handed participants were tested. In a control condition, MEPs were recorded in right flexor carpi radialis (rFCR) following 120% resting MT TMS over left M1. In 11 experimental conditions, 1 mA (peak-to-peak) 140 Hz (30, 100, 500 ms) or 670 Hz (6, 12, 100, 500 ms) tACS, or 100-640 Hz (6, 12, 100, 500 ms) transcranial random noise stimulation (tRNS), was delivered over right M1, 6 ms in advance of the TMS. IHF was obtained by conditioning with 30 ms (but not 100 or 500 ms) 140 Hz tACS. The magnitude of IHF (12% increase; d = 0.56 (0.21-0.98)) was within the range reported for dual-coil TMS studies. Conditioning by 670 Hz tACS or tRNS had no effect. Our findings indicate that short bursts of 140 Hz tACS, applied over M1, have distributed effects similar to those of subthreshold TMS.

Dual-site TMS as a tool to probe effective interactions within the motor network: a review

Dual-site transcranial magnetic stimulation (ds-TMS) is well suited to investigate the causal effect of distant brain regions on the primary motor cortex, both at rest and during motor performance and learning. However, given the broad set of stimulation parameters, clarity about which parameters are most effective for identifying particular interactions is lacking. Here, evidence describing inter- and intra-hemispheric interactions during rest and in the context of motor tasks is reviewed. Our aims are threefold: (1) provide a detailed overview of ds-TMS literature regarding inter- and intra-hemispheric connectivity; (2) describe the applicability and contributions of these interactions to motor control, and; (3) discuss the practical implications and future directions. Of the 3659 studies screened, 109 were included and discussed. Overall, there is remarkable variability in the experimental context for assessing ds-TMS interactions, as well as in the use and reporting of stimulation parameters, hindering a quantitative comparison of results across studies. Further studies examining ds-TMS interactions in a systematic manner, and in which all critical parameters are carefully reported, are needed.

Cerebral Hemodynamic Changes during Unaffected Handgrip Exercises in Stroke Patients: An fNIRS Study

This study aimed to assess the effect of the altered strength of the sound limb on the hemodynamics in the affected brain of stroke patients. We recruited 20 stroke patients to detect changes in the HbO concentrations in the bilateral prefrontal cortex (PFC), sensorimotor cortex (SMC), and occipital lobe (OL). We performed functional near-infrared spectroscopy (fNIRS) to detect changes in oxyhemoglobin (HbO) concentrations in regions of interest (ROIs) in the bilateral cerebral hemispheres of stroke patients while they performed 20%, 50%, and 80% maximal voluntary contraction (MVC) levels of handgrip tasks with the unaffected hands. The results suggest that when patients performed handgrip tasks with 50% of the MVC force, SMC in the affected cerebral hemisphere was strongly activated and the change in the HbO concentration was similar to that of the handgrip with 80% of MVC. When the force was 50% of MVC, the SMC in the affected hemisphere showed a more proportional activation than that at 80% MVC. Overall, this research suggests that stroke patients with a poor upper limb function should perform motor training with their sound hands at 50% of the MVC grip task to activate the ipsilesional hemisphere.

Reduced isometric knee extensor force following anodal transcranial direct current stimulation of the ipsilateral motor cortex

BACKGROUND

The goal of this study was to determine if 10-min of anodal transcranial direct current stimulation (a-tDCS) to the motor cortex (M1) is capable of modulating quadriceps isometric maximal voluntary contraction (MVC) force or fatigue endurance contralateral or ipsilateral to the stimulation site.

METHODS

In a randomized, cross-over design, 16 (8 females) individuals underwent two sessions of a-tDCS and two sham tDCS (s-tDCS) sessions targeting the left M1 (all participants were right limb dominant), with testing of either the left (ipsilateral) or right (contralateral) quadriceps. Knee extensor (KE) MVC force was recorded prior to and following the a-tDCS and s-tDCS protocols. Additionally, a repetitive MVC fatiguing protocol (12 MVCs with work-rest ratio of 5:10-s) was completed following each tDCS protocol.

RESULTS

There was a significant interaction effect for stimulation condition x leg tested x time [F(1,60) = 7.156, p = 0.010, ηp2 = 0.11], which revealed a significant absolute KE MVC force reduction in the contralateral leg following s-tDCS (p < 0.001, d = 1.2) and in the ipsilateral leg following a-tDCS (p < 0.001, d = 1.09). A significant interaction effect for condition x leg tested [F(1,56) = 8.12, p = 0.006, ηp2 = 0.13], showed a significantly lower ipsilateral quadriceps (to tDCS) relative MVC force with a-tDCS, versus s-tDCS [t(15) = -3.07, p = 0.016, d = -0.77]. There was no significant difference between the relative contralateral quadriceps (to tDCS) MVC force for a-tDCS and s-tDCS. Although there was an overall significant [F(1,56) = 8.36, p < 0.001] 12.1% force decrease between the first and twelfth MVC repetitions, there were no significant main or interaction effects for fatigue index force.

CONCLUSION

a-tDCS may be ineffective at increasing maximal force or endurance and instead may be detrimental to quadriceps force production.

Cortical hyperexcitability and plasticity in Alzheimer's disease: developments in understanding and management

INTRODUCTION

Transcranial magnetic stimulation (TMS) is a non-invasive neurophysiological tool that provides important insights into Alzheimer's Disease (AD). A significant body of work utilizing TMS techniques has explored the pathophysiological relevance of cortical hyperexcitability and plasticity in AD and their modulation in novel therapies.

AREAS COVERED

This review examines the technique of TMS, the use of TMS to examine specific features of cortical excitability and the use of TMS techniques to modulate cortical function. A search was performed utilizing the PubMed database to identify key studies utilizing TMS to examine cortical hyperexcitability and plasticity in Alzheimer's dementia. We then translate this understanding to the study of Alzheimer's disease pathophysiology, examining the underlying neurophysiologic links contributing to these twin signatures, cortical hyperexcitability and abnormal plasticity, in the cortical dysfunction characterizing AD. Finally, we examine utilization of TMS excitability to guide targeted therapies and, through the use of repetitive TMS (rTMS), modulate cortical plasticity.

EXPERT OPINION

The examination of cortical hyperexcitability and plasticity with TMS has potential to optimize and expand the window of therapeutic interventions in AD, though remains at relatively early stage of development.

Transcranial magnetic stimulation of the brain: What is stimulated? - A consensus and critical position paper

Transcranial (electro)magnetic stimulation (TMS) is currently the method of choice to non-invasively induce neural activity in the human brain. A single transcranial stimulus induces a time-varying electric field in the brain that may evoke action potentials in cortical neurons. The spatial relationship between the locally induced electric field and the stimulated neurons determines axonal depolarization. The induced electric field is influenced by the conductive properties of the tissue compartments and is strongest in the superficial parts of the targeted cortical gyri and underlying white matter. TMS likely targets axons of both excitatory and inhibitory neurons. The propensity of individual axons to fire an action potential in response to TMS depends on their geometry, myelination and spatial relation to the imposed electric field and the physiological state of the neuron. The latter is determined by its transsynaptic dendritic and somatic inputs, intrinsic membrane potential and firing rate. Modeling work suggests that the primary target of TMS is axonal terminals in the crown top and lip regions of cortical gyri. The induced electric field may additionally excite bends of myelinated axons in the juxtacortical white matter below the gyral crown. Neuronal excitation spreads ortho- and antidromically along the stimulated axons and causes secondary excitation of connected neuronal populations within local intracortical microcircuits in the target area. Axonal and transsynaptic spread of excitation also occurs along cortico-cortical and cortico-subcortical connections, impacting on neuronal activity in the targeted network. Both local and remote neural excitation depend critically on the functional state of the stimulated target area and network. TMS also causes substantial direct co-stimulation of the peripheral nervous system. Peripheral co-excitation propagates centrally in auditory and somatosensory networks, but also produces brain responses in other networks subserving multisensory integration, orienting or arousal. The complexity of the response to TMS warrants cautious interpretation of its physiological and behavioural consequences, and a deeper understanding of the mechanistic underpinnings of TMS will be critical for advancing it as a scientific and therapeutic tool.

Transcranial Magnetic Stimulation and Neocortical Neurons: The Micro-Macro Connection

Understanding the operation of cortical circuits is an important and necessary task in both neuroscience and neurorehabilitation. The functioning of the neocortex results from integrative neuronal activity, which can be probed non-invasively by transcranial magnetic stimulation (TMS). Despite a clear indication of the direct involvement of cortical neurons in TMS, no explicit connection model has been made between the microscopic neuronal landscape and the macroscopic TMS outcome. Here we have performed an integrative review of multidisciplinary evidence regarding motor cortex neurocytology and TMS-related neurophysiology with the aim of elucidating the micro–macro connections underlying TMS. Neurocytological evidence from animal and human studies has been reviewed to describe the landscape of the cortical neurons covering the taxonomy, morphology, circuit wiring, and excitatory–inhibitory balance. Evidence from TMS studies in healthy humans is discussed, with emphasis on the TMS pulse and paradigm selectivity that reflect the underlying neural circuitry constitution. As a result, we propose a preliminary neuronal model of the human motor cortex and then link the TMS mechanisms with the neuronal model by stimulus intensity, direction of induced current, and paired-pulse timing. As TMS bears great developmental potential for both a probe and modulator of neural network activity and neurotransmission, the connection model will act as a foundation for future combined studies of neurocytology and neurophysiology, as well as the technical advances and application of TMS.

Myoclonus generators in sialidosis

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The cortical origin of myoclonus in sialidosis does not fully explain the phenomena.

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We used electrophysiology to show a possible subcortical source for the myoclonus.

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Correct understanding of this physiopathology may help improve treatment.

Objective

Sialidosis is an inborn error of metabolism. There is evidence that the myoclonic movements observed in this disorder have a cortical origin, but this mechanism does not fully explain the bilaterally synchronous myoclonus activity frequently observed in many patients. We present evidence of a subcortical basis for synchronous myoclonic phenomena.

Methods

Electromyographic investigations were undertaken in two molecularly and biochemically confirmed patients with sialidosis type-1.

Results

The EMG recordings showed clear episodes of bilaterally synchronous myoclonic activity in contralateral homologous muscles. We also observed a high muscular-muscular coherence with near-zero time-lag between these muscles.

Conclusion

The absence of coherence phase lag between the right-and-left homologous muscles during synchronous events indicates that a unilateral cortical source cannot fully explain the myoclonic activity. There must exist a subcortical mechanism for bilateral synchronization accounting for this phenomenon.

Significance

Understanding this mechanism may illuminate cortical-subcortical relationships in myoclonus.

Cortical Stimulation Paired With Volitional Unimanual Movement Affects Interhemispheric Communication

Cortical stimulation (CS) of the motor cortex can cause excitability changes in both hemispheres, showing potential to be a technique for clinical rehabilitation of motor function. However, previous studies that have investigated the effects of delivering CS during movement typically focus on a single hemisphere. On the other hand, studies exploring interhemispheric interactions typically deliver CS at rest. We sought to bridge these two approaches by documenting the consequences of delivering CS to a single motor cortex during different phases of contralateral and ipsilateral limb movement, and simultaneously assessing changes in interactions within and between the hemispheres via local field potential (LFP) recordings. Three macaques were trained in a unimanual reaction time (RT) task and implanted with epidural or intracortical electrodes over bilateral motor cortices. During a given session CS was delivered to one hemisphere with respect to movements of either the contralateral or ipsilateral limb. Stimulation delivered before contralateral limb movement onset shortened the contralateral limb RT. In contrast, stimulation delivered after the end of contralateral movement increased contralateral RT but decreased ipsilateral RT. Stimulation delivered before ipsilateral limb movement decreased ipsilateral RT. All other stimulus conditions as well as random stimulation and periodic stimulation did not have consistently significant effects on either limb. Simultaneous LFP recordings from one animal revealed correlations between changes in interhemispheric alpha band coherence and changes in RT, suggesting that alpha activity may be indicative of interhemispheric communication. These results show that changes caused by CS to the functional coupling within and between precentral cortices is contingent on the timing of CS relative to movement.

Central nervous system physiology

This is the second chapter of the series on the use of clinical neurophysiology for the study of movement disorders. It focusses on methods that can be used to probe neural circuits in brain and spinal cord. These include use of spinal and supraspinal reflexes to probe the integrity of transmission in specific pathways; transcranial methods of brain stimulation such as transcranial magnetic stimulation and transcranial direct current stimulation, which activate or modulate (respectively) the activity of populations of central neurones; EEG methods, both in conjunction with brain stimulation or with behavioural measures that record the activity of populations of central neurones; and pure behavioural measures that allow us to build conceptual models of motor control. The methods are discussed mainly in relation to work on healthy individuals. Later chapters will focus specifically on changes caused by pathology.

Neurophysiological modulations in the (pre)motor-motor network underlying age-related increases in reaction time and the role of GABA levels - a bimodal TMS-MRS study

It has been argued that age-related changes in the neurochemical and neurophysiological properties of the GABAergic system may underlie increases in reaction time (RT) in older adults. However, the role of GABA levels within the sensorimotor cortices (SMC) in mediating interhemispheric interactions (IHi) during the processing stage of a fast motor response, as well as how both properties explain interindividual differences in RT, are not yet fully understood. In this study, edited magnetic resonance spectroscopy (MRS) was combined with dual-site transcranial magnetic stimulation (dsTMS) for probing GABA+ levels in bilateral SMC and task-related neurophysiological modulations in corticospinal excitability (CSE), and primary motor cortex (M1)-M1 and dorsal premotor cortex (PMd)-M1 IHi, respectively. Both CSE and IHi were assessed during the preparatory and premotor period of a delayed choice RT task. Data were collected from 25 young (aged 18-33 years) and 28 older (aged 60-74 years) healthy adults. Our results demonstrated that older as compared to younger adults exhibited a reduced bilateral CSE suppression, as well as a reduced magnitude of long latency M1-M1 and PMd-M1 disinhibition during the preparatory period, irrespective of the direction of the IHi. Importantly, in older adults, the GABA+ levels in bilateral SMC partially accounted for task-related neurophysiological modulations as well as individual differences in RT. In contrast, in young adults, neither task-related neurophysiological modulations, nor individual differences in RT were associated with SMC GABA+ levels. In conclusion, this study contributes to a comprehensive initial understanding of how age-related differences in neurochemical properties and neurophysiological processes are related to increases in RT.

Causal roles of prefrontal cortex during spontaneous perceptual switching are determined by brain state dynamics

The prefrontal cortex (PFC) is thought to orchestrate cognitive dynamics. However, in tests of bistable visual perception, no direct evidence supporting such presumable causal roles of the PFC has been reported except for a recent work. Here, using a novel brain-state-dependent neural stimulation system, we identified causal effects on percept dynamics in three PFC activities—right frontal eye fields, dorsolateral PFC (DLPFC), and inferior frontal cortex (IFC). The causality is behaviourally detectable only when we track brain state dynamics and modulate the PFC activity in brain-state-/state-history-dependent manners. The behavioural effects are underpinned by transient neural changes in the brain state dynamics, and such neural effects are quantitatively explainable by structural transformations of the hypothetical energy landscapes. Moreover, these findings indicate distinct functions of the three PFC areas: in particular, the DLPFC enhances the integration of two PFC-active brain states, whereas IFC promotes the functional segregation between them. This work resolves the controversy over the PFC roles in spontaneous perceptual switching and underlines brain state dynamics in fine investigations of brain-behaviour causality.

A cube that seems to shift its spatial arrangement as you keep looking; the elegant silhouette of a pirouetting dancer, which starts to spin in the opposite direction the more you stare at it; an illustration that shows two profiles – or is it a vase? These optical illusions are examples of bistable visual perception. Beyond their entertaining aspect, they provide a way for scientists to explore the dynamics of human consciousness, and the neural regions involved in this process.

Some studies show that bistable visual perception is associated with the activation of the prefrontal cortex, a brain area involved in complex cognitive processes. However, it is unclear whether this region is required for the illusions to emerge. Some research has showed that even if sections of the prefrontal cortex are temporally deactivated, participants can still experience the illusions.

Instead, Takamitsu Watanabe proposes that bistable visual perception is a process tied to dynamic brain states – that is, that distinct regions of the prefontal cortex are required for this fluctuating visual awareness, depending on the state of the whole brain. Such causal link cannot be observed if brain activity is not tracked closely.

To investigate this, the brain states of 65 participants were recorded as individuals were experiencing the optical illusions; the activity of their various brain regions could therefore be mapped, and then areas of the prefrontal cortex could precisely be inhibited at the right time using transcranial magnetic stimulation. This revealed that, indeed, prefrontal cortex regions were necessary for bistable visual perception, but not in a simple way. Instead, which ones were required and when depended on activity dynamics taking place in the whole brain. Overall, these results indicate that monitoring brain states is necessary to better understand – and ultimately, control – the neural pathways underlying perception and behaviour.

Voxel-Wise Analysis of Structural and Functional MRI for Lateralization of Handedness in College Students

The brain structural and functional basis of lateralization in handedness is largely unclear. This study aimed to explore this issue by using voxel-mirrored homotopic connectivity (VMHC) measured by resting-state functional MRI (R-fMRI) and gray matter asymmetry index (AI) by high-resolution anatomical images. A total of 50 healthy subjects were included, among them were 13 left-handers, 24 right-handers, and 13 mixed-handers. Structural and R-fMRI data of all subjects were collected. There were significant differences in VMHC among the three groups in lateral temporal-occipital, orbitofrontal, and primary hand motor regions. Meanwhile, there were significant differences in AI that existed in medial prefrontal, superior frontal, and superior temporal regions. Besides, the correlation analysis showed that the closer the handedness score to the extreme of the left-handedness (LH), the stronger the interhemispheric functional connectivity, as well as more leftward gray matter. In general, left/mixed-handedness (MH) showed stronger functional homotopy in the transmodal association regions that depend on the integrity of the corpus callosum, but more variable in primary sensorimotor cortices. Furthermore, the group differences in VMHC largely align with that in AI. We located the specific regions for LH/MH from the perspective of structural specification and functional integration, suggesting the plasticity of hand movement and different patterns of emotional processing.

Paradoxical facilitation alongside interhemispheric inhibition

Neurophysiological experiments using transcranial magnetic stimulation (TMS) have sought to probe the function of the motor division of the corpus callosum. Primary motor cortex sends projections via the corpus callosum with a net inhibitory influence on the homologous region of the opposite hemisphere. Interhemispheric inhibition (IHI) experiments probe this inhibitory pathway. A test stimulus (TS) delivered to the motor cortex in one hemisphere elicits motor evoked potentials (MEPs) in a target muscle, while a conditioning stimulus (CS) applied to the homologous region of the opposite hemisphere modulates the effect of the TS. We predicted that large CS MEPs would be associated with increased IHI since they should be a reliable index of how effectively contralateral motor cortex was stimulated and therefore of the magnitude of interhemispheric inhibition. However, we observed a strong tendency for larger CS MEPs to be associated with reduced interhemispheric inhibition which in the extreme lead to a net effect of facilitation. This surprising effect was large, systematic, and observed in nearly all participants. We outline several hypotheses for mechanisms which may underlie this phenomenon to guide future research.

Sensitivity of amplitude and phase based MEG measures of interhemispheric connectivity during unilateral finger movements

Interactions between different brain regions can be revealed by dependencies between their neuronal oscillations. We examined the sensitivity of different oscillatory connectivity measures in revealing interhemispheric interactions between primary motor cortices (M1s) during unilateral finger movements. Based on frequency, amplitude, and phase of the oscillations, a number of metrics have been developed to measure connectivity between brain regions, and each metric has its own strengths, weaknesses, and pitfalls. Taking advantage of the well-known movement-related modulations of oscillatory amplitude in M1s, this study compared and contrasted a number of leading connectivity metrics during distinct phases of oscillatory power changes. Between M1s during unilateral movements, we found that phase-based metrics were effective at revealing connectivity during the beta (15-35 Hz) rebound period linked to movement termination, but not during the early period of beta desynchronization occurring during the movement itself. Amplitude correlation metrics revealed robust connectivity during both periods. Techniques for estimating the direction of connectivity had limited success. Granger Causality was not well suited to studying these connections because it was strongly confounded by differences in signal-to-noise ratio linked to modulation of beta amplitude occurring during the task. Phase slope index was suggestive but not conclusive of a unidirectional influence between motor cortices during the beta rebound. Our findings suggest that a combination of amplitude and phase-based metrics is likely required to fully characterize connectivity during task protocols that involve modulation of oscillatory power, and that amplitude-based metrics appear to be more sensitive despite the lack of directional information.

Functional and structural impairment of transcallosal motor fibres in ALS: a study using transcranial magnetic stimulation, diffusion tensor imaging, and diffusion weighted spectroscopy

Imaging studies showed that the structure of the corpus callosum (CC) is affected in amyotrophic lateral sclerosis (ALS). Some clinical studies also suggest that interhemispheric connectivity is altered, since mirror movements seem to occur in ALS. Finally, reduced interhemispheric inhibition (IHI), studied by transcranial magnetic stimulation (TMS), has been reported. It is not known whether there is any association between these findings. Here, we studied the integrity of the CC in ALS on the morphological, the functional, the electrophysiological, and the clinical level. Twenty-seven right-handed ALS patients and 21 healthy right-handed controls were included. Mirror activity (MA) was quantified using surface EMG. Diffusion tensor imaging tractography was used to segment the CC and quantify fractional anisotropy (FA). We studied the diffusivity of the intra-axonal markers N-acetylaspartate+N-acetyl aspartyl glutamate D(tNAA) within the CC. IHI was studied as a marker of CC function using a double-pulse TMS protocol. ALS patients showed significantly decreased FA in the motor segment of the CC (p < 0.01), and IHI was significantly reduced compared to controls (p = 0.01). However, no differences were observed regarding D(tNAA) and MA. The morphological as well as the functional integrity of the CC are altered in ALS. IHI was reduced in ALS, associated with decreased FA in the motor CC. Patients did not exhibit increased MA. Also, no differences within the CC were observed using diffusion-weighted spectroscopy. IHI might serve as a marker of transcallosal pathway disruption in ALS, even before clinical deficits become apparent.

Modulation of Interhemispheric Inhibition between Primary Motor Cortices Induced by Manual Motor Imitation: A Transcranial Magnetic Stimulation Study

Imitation has been proven effective in motor development and neurorehabilitation. However, the relationship between imitation and interhemispheric inhibition (IHI) remains unclear. Transcranial magnetic stimulation (TMS) can be used to investigate IHI. In this study, the modification effects of IHI resulting from mirror neuron system (MNS) activation during different imitations are addressed. We measured IHI between homologous primary motor cortex (M1) by analyzing the ipsilateral silent period (iSP) evoked by single-pulse focal TMS during imitation and analyzed the respective IHI modulation during and after different patterns of imitation. Our main results showed that throughout anatomical imitation, significant time-course changes of iSP duration through the experiment were observed in both directions. iSP duration declined from the pre-imitation time point to the post-imitation time point and did not return to baseline after 30 min rest. We also observed significant iSP reduction from the right hemisphere to the left hemisphere during anatomical and specular imitation, compared with non-imitative movement. Our findings indicate that using anatomical imitation in action observation and execution therapy promotes functional recovery in neurorehabilitation by regulating IHI.

Motor training strengthens corticospinal suppression during movement preparation

Movement preparation involves a broad suppression in the excitability of the corticospinal pathway, a phenomenon called preparatory suppression. Here, we show that motor training strengthens preparatory suppression and that this strengthening is associated with faster reaction times. Our findings highlight a key role of preparatory suppression in training-driven behavioral improvements.

Probing interhemispheric dorsal premotor-primary motor cortex interactions with threshold hunting transcranial magnetic stimulation

OBJECTIVE

To characterise the effect of altering transcranial magnetic stimulation parameters on the magnitude of interhemispheric inhibition (IHI) from dorsal premotor (PMd) to primary motor cortex (M1).

METHOD

We used a fully automated adaptive threshold hunting paradigm to quantify PMd-M1 IHI across a range of conditioning stimulus (CS) intensities (90%, 110%, 130% of resting motor threshold, rMT) and interstimulus intervals (ISIs) (8, 10, 40 ms). M1-M1 IHI was examined with CS intensities of 110%, 120%, and 130% rMT and ISIs of 10 and 40 ms. Two test coil orientations (inducing posterior-anterior or anterior-posterior current) were used.

RESULTS

PMd-M1 IHI was obtained consistently with posterior-anterior (but not anterior-posterior) test stimuli and increased with CS intensity. M1-M1 IHI was expressed across all conditions and increased with CS intensity when posterior-anterior but not anterior-posterior induced current was used.

CONCLUSIONS

The expression of PMd-M1 IHI is contingent on test coil orientation (requiring posterior-anterior induced current) and increases as a function of CS intensity. The expression of M1-M1 IHI is not dependent on test coil orientation.

SIGNIFICANCE

We defined a range of parameters that elicit reliable PMd-M1 IHI. This (threshold hunting) methodology may provide a means to quantify premotor-motor pathology and reveal novel quantitative biomarkers.

A TMS study of preparatory suppression in binge drinkers

Binge drinking consists in a pattern of consumption characterised by the repeated alternation between massive alcohol intakes and abstinence periods. A continuum hypothesis suggests that this drinking endeavour represents an early stage of alcohol dependence rather than a separate phenomenon. Among the variety of alterations in alcohol-dependent individuals (ADIs), one has to do with the motor system, which does not show a normal pattern of activity during action preparation. In healthy controls (HCs), motor-evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) over primary motor cortex (M1) show both facilitation and suppression effects, depending on the time and setting of TMS during action preparation. A recent study focusing on the suppression component revealed that this aspect of preparatory activity is abnormally weak in ADIs and that this defect scales with the risk of relapse. In the present study, we tested whether binge drinkers (BDs) present a similar deficit. To do so, we recorded MEPs in a set of hand muscles applying TMS in 20 BDs and in 20 matched HCs while they were preparing index finger responses in an instructed-delay choice reaction time task. Consistent with past research, the MEP data in HCs revealed a strong MEP suppression in this task. This effect was evident in all hand muscles, regardless of whether they were relevant or irrelevant in the task. BDs also showed some preparatory suppression, yet this effect was less consistent, especially in the prime mover of the responding hand. These findings suggest abnormal preparatory activity in BDs, similar to alcohol-dependent patients, though some of the current results also raise new questions regarding the significance of these observations.

Measuring latency distribution of transcallosal fibers using transcranial magnetic stimulation

BACKGROUND

Neuroimaging technology is being developed to enable non-invasive mapping of the latency distribution of cortical projection pathways in white matter, and correlative clinical neurophysiological techniques would be valuable for mutual verification. Interhemispheric interaction through the corpus callosum can be measured with interhemispheric facilitation and inhibition using transcranial magnetic stimulation.

OBJECTIVE

To develop a method for determining the latency distribution of the transcallosal fibers with transcranial magnetic stimulation.

METHODS

We measured the precise time courses of interhemispheric facilitation and inhibition with a conditioning-test paired-pulse magnetic stimulation paradigm. The conditioning stimulus was applied to the right primary motor cortex and the test stimulus was applied to the left primary motor cortex. The interstimulus interval was set at 0.1 ms resolution. The proportions of transcallosal fibers with different conduction velocities were calculated by measuring the changes in magnitudes of interhemispheric facilitation and inhibition with interstimulus interval.

RESULTS

Both interhemispheric facilitation and inhibition increased with increment in interstimulus interval. The magnitude of interhemispheric facilitation was correlated with that of interhemispheric inhibition. The latency distribution of transcallosal fibers measured with interhemispheric facilitation was also correlated with that measured with interhemispheric inhibition.

CONCLUSIONS

The data can be interpreted as latency distribution of transcallosal fibers. Interhemispheric interaction measured with transcranial magnetic stimulation is a promising technique to determine the latency distribution of the transcallosal fibers. Similar techniques could be developed for other cortical pathways.

Intermittent theta burst stimulation facilitates functional connectivity from the dorsal premotor cortex to primary motor cortex

Background

Motor information in the brain is transmitted from the dorsal premotor cortex (PMd) to the primary motor cortex (M1), where it is further processed and relayed to the spinal cord to eventually generate muscle movement. However, how information from the PMd affects M1 processing and the final output is unclear. Here, we applied intermittent theta burst stimulation (iTBS) to the PMd to alter cortical excitability not only at the application site but also at the PMd projection site of M1. We aimed to determine how PMd iTBS–altered information changed M1 processing and the corticospinal output.

Methods

In total, 16 young, healthy participants underwent PMd iTBS with 600 pulses (iTBS600) or sham-iTBS600. Corticospinal excitability, short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) were measured using transcranial magnetic stimulation before and up to 60 min after stimulation.

Results

Corticospinal excitability in M1 was significantly greater 15 min after PMd iTBS600 than that after sham-iTBS600 (p = 0.012). Compared with that after sham-iTBS600, at 0 (p = 0.014) and 15 (p = 0.037) min after iTBS600, SICI in M1 was significantly decreased, whereas 15 min after iTBS600, ICF in M1 was significantly increased (p = 0.033).

Conclusion

Our results suggested that projections from the PMd to M1 facilitated M1 corticospinal output and that this facilitation may be attributable in part to decreased intracortical inhibition and increased intracortical facilitation in M1. Such a facilitatory network may inform future understanding of the allocation of resources to achieve optimal motion output.

Implication of the ipsilateral motor network in unilateral voluntary muscle contraction: the cross-activation phenomenon

Voluntary force production requires that the brain produces and transmits a motor command to the muscles. It is widely acknowledged that motor commands are executed from the primary motor cortex (M1) located in the contralateral hemisphere. However, involvement of M1 located in the ipsilateral hemisphere during moderate to high levels of unilateral muscle contractions (>30% of the maximum) has been disclosed in recent years. This phenomenon has been termed cross-activation. The activation of the ipsilateral M1 relies on complex inhibitory and excitatory interhemispheric interactions mediated via the corpus callosum and modulated according to the contraction level. The regulatory mechanisms underlying these interhemispheric interactions, especially excitatory ones, remain vague, and contradictions exist in the literature. In addition, very little is known regarding the possibility that other pathways could also mediate the cross-activation. In the present review, we will therefore summarize the concept of cross-activation during unilateral voluntary muscle contraction and explore the associated mechanisms and other nervous system pathways underpinning this response. A broader knowledge of these mechanisms would consequently allow a better comprehension of the motor system as a whole, as distant brain networks working together to produce the motor command.

The Role of Primary Motor Cortex: More Than Movement Execution

The predominant role of the primary motor cortex (M1) in motor execution is well acknowledged. However, additional roles of M1 are getting evident in humans owing to advances in noninvasive brain stimulation (NIBS) techniques. This review collates such studies in humans and proposes that M1 also plays a key role in higher cognitive processes. The review commences with the studies that have investigated the nature of connectivity of M1 with other cortical regions in light of studies based on NIBS. The review then moves on to discuss the studies that have demonstrated the role of M1 in higher cognitive processes such as attention, motor learning, motor consolidation, movement inhibition, somatomotor response, and movement imagery. Overall, the purpose of the review is to highlight the additional role of M1 in motor cognition besides motor control, which remains unexplored.

Modulating Brain Networks With Transcranial Magnetic Stimulation Over the Primary Motor Cortex: A Concurrent TMS/fMRI Study

Stimulating the primary motor cortex (M1) using transcranial magnetic stimulation (TMS) causes unique multisensory experience such as the targeted muscle activity, afferent/reafferent sensory feedback, tactile sensation over the scalp and “click” sound. Although the human M1 has been intensively investigated using TMS, the experience of the M1 stimulation has not been elucidated at the whole brain. Here, using concurrent TMS/fMRI, we investigated the acute effect of the M1 stimulation of functional brain networks during task and at rest. A short train of 1 Hz TMS pulses applied to individuals’ hand area in the M1 during motor execution or at rest. Employing the independent component analysis (ICA), we showed the M1 stimulation decreased the motor networks activity when the networks were engaged in the task and increased the deactivation of networks when the networks were not involved in the ongoing task. The M1 stimulation induced the activation in the key networks involved in bodily self-consciousness (BSC) including the insular and rolandic operculum systems regardless of states. The degree of activation in these networks was prominent at rest compared to task conditions, showing the state-dependent TMS effect. Furthermore, we demonstrated that the M1 stimulation modulated other domain-general networks such as the default mode network (DMN) and attention network and the inter-network connectivity between these networks. Our results showed that the M1 stimulation induced the widespread changes in the brain at the targeted system as well as non-motor, remote brain networks, specifically related to the BSC. Our findings shed light on understanding the neural mechanism of the complex and multisensory experience of the M1 stimulation.

Mirror movement-like muscle hypertonia stroke model based on ipsilateral weight load

In stroke patients, muscle tone on the unaffected side is often increased during voluntary tasks. This is known as a mirror movement and might be an impediment to function recovery, but its neural background is still unclear. In this study, we investigated the effect of unilateral muscle hypertonia on ipsilateral cortical activity and contralateral motor function. Fourteen right-handed healthy young subjects lifted a weight of 10% body weight with the right upper limb to increase muscle tone (weight task), while no weight lifting was set as the control 'nonweight' task. We recorded the motor-evoked potential (MEP), resting motor threshold and H-reflex from the left flexor carpi radialis muscle during both tasks. To estimate the functional effect of the weight task, subjects performed the 'Purdue pegboard test', consisting of examination for 30 seconds (peg-30) and assembly for 60 seconds (peg assembly). Left-hand grip strength was also measured. When subjects performed the weight task, the MEP amplitude increased significantly and the MT decreased significantly. There was no significant difference of H-reflex amplitude between the two tasks. No significant difference of the peg-30 score was observed between weight and nonweight tasks, but the peg assembly score was significantly lower during the weight task. Grip strength showed a significant increase during the weight task. These results indicate that the present weight load model may have the potential to advance our understanding of the mechanisms underlying mirror movements after stroke.

Rapid crossed responses in an intrinsic hand muscle during perturbed bimanual movements

Mechanical perturbations in one upper limb often elicit corrective responses in both the perturbed as well as its contralateral and unperturbed counterpart. These crossed corrective responses have been shown to be sensitive to the bimanual requirements of the perturbation, but crossed responses (CRs) in hand muscles are far less well studied. Here, we investigate corrective CRs in an intrinsic hand muscle, the first dorsal interosseous (1DI), to clockwise and anticlockwise mechanical perturbations to the contralateral index finger while participants performed a bimanual finger abduction task. We found that the CRs in the unperturbed 1DI were sensitive to the direction of the perturbation of the contralateral index finger. However, the size of the CRs was not sensitive to the amplitude of the contralateral perturbation nor its context within the bimanual task. The onset latency of the CRs was too fast to be purely transcortical (<70 ms) in 12/12 participants. This confirms that during isolated bimanual finger movements, sensory feedback from one hand can influence the other, but the pathways mediating the earliest components of this interaction are likely to involve subcortical systems such as the brainstem or spinal cord, which may afford less flexibility to the task demands.NEW & NOTEWORTHY An intrinsic hand muscle shows a crossed response to a perturbation of the contralateral index finger. The crossed response is dependent on the direction of the contralateral perturbation but not on the amplitude or the bimanual requirements of the movement, suggesting a far less flexible control policy than those governing crossed responses in more proximal muscles. The crossed response is too fast to be purely mediated by transcortical pathways, suggesting subcortical contributions.

Effects of sonication parameters on transcranial focused ultrasound brain stimulation in an ovine model

Low-intensity focused ultrasound (FUS) has significant potential as a non-invasive brain stimulation modality and novel technique for functional brain mapping, particularly with its advantage of greater spatial selectivity and depth penetration compared to existing non-invasive brain stimulation techniques. As previous studies, primarily carried out in small animals, have demonstrated that sonication parameters affect the stimulation efficiency, further investigation in large animals is necessary to translate this technique into clinical practice. In the present study, we examined the effects of sonication parameters on the transient modification of excitability of cortical and thalamic areas in an ovine model. Guided by anatomical and functional neuroimaging data specific to each animal, 250 kHz FUS was transcranially applied to the primary sensorimotor area associated with the right hind limb and its thalamic projection in sheep (n = 10) across multiple sessions using various combinations of sonication parameters. The degree of effect from FUS was assessed through electrophysiological responses, through analysis of electromyogram and electroencephalographic somatosensory evoked potentials for evaluation of excitatory and suppressive effects, respectively. We found that the modulatory effects were transient and reversible, with specific sonication parameters outperforming others in modulating regional brain activity. Magnetic resonance imaging and histological analysis conducted at different time points after the final sonication session, as well as behavioral observations, showed that repeated exposure to FUS did not damage the underlying brain tissue. Our results suggest that FUS-mediated, non-invasive, region-specific bimodal neuromodulation can be safely achieved in an ovine model, indicating its potential for translation into human studies.

Motor cortex signals for each arm are mixed across hemispheres and neurons yet partitioned within the population response

Motor cortex (M1) has lateralized outputs, yet neurons can be active during movements of either arm. What is the nature and role of activity across the two hemispheres? We recorded muscles and neurons bilaterally while monkeys cycled with each arm. Most neurons were active during movement of either arm. Responses were strongly arm-dependent, raising two possibilities. First, population-level signals might differ depending on the arm used. Second, the same population-level signals might be present, but distributed differently across neurons. The data supported this second hypothesis. Muscle activity was accurately predicted by activity in either the ipsilateral or contralateral hemisphere. More generally, we failed to find signals unique to the contralateral hemisphere. Yet if signals are shared across hemispheres, how do they avoid impacting the wrong arm? We found that activity related to each arm occupies a distinct subspace, enabling muscle-activity decoders to naturally ignore signals related to the other arm.

Investigational and Therapeutic Applications of Transcranial Magnetic Stimulation in Schizophrenia

PURPOSE OF REVIEW

This current review summarizes the investigational and therapeutic applications of transcranial magnetic stimulation (TMS) in schizophrenia.

RECENT FINDINGS

Fairly consistent findings of an impaired cortical excitation-inhibition balance, cortical plasticity, and motor resonance have been reported in schizophrenia. Cortical connectivity impairments have also been demonstrated in motor and prefrontal brain regions. In terms of treatment, the best support is for 1-Hz TMS to the left temporoparietal cortex for the short-term treatment of persistent auditory hallucinations. High-frequency TMS to the left prefrontal cortex improves negative and cognitive symptoms, but with inconsistent and small effects. TMS combined with diverse brain mapping techniques and clinical evaluation can unravel critical brain-behavior relationships relevant to schizophrenia. These provide critical support to the conceptualization of schizophrenia as a connectopathy with anomalous cortical plasticity. Adaptive modulation of these aberrant brain networks in a neuroscience-informed manner drives short-term therapeutic gains in difficult-to-treat symptoms of schizophrenia.

Comparison of bilateral and unilateral upper limb training in people with stroke: A systematic review and meta-analysis

Background and objectives

Bilateral upper limb training (BULT) and unilateral upper limb training (UULT) are two effective strategies for the recovery of upper limb motor function after stroke. This meta-analysis aimed to compare the improvements in motor impairment and functional performances of people with stroke after BULT and UULT.

Research design and methods

This systematic review and meta-analysis identified 21 randomized controlled trials (RCTs) met the eligibility criteria from CINAHL, Medline, Embase, Cochrane Library and PubMed. The outcome measures were the Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), Action Research Arm Test (ARAT) and Box and Block Test (BBT), which are validated measures of upper limb function.

Results

Twenty-one studies involving 842 subjects with stroke were included. Compared with UULT, BULT yielded a significantly greater mean difference (MD) in the FMA-UE (MD = 2.21, 95% Confidence Interval (CI), 0.12 to 4.30, p = 0.04; I² = 86%, p<0.001). However, a comparison of BULT and UULT yielded insignificant mean difference (MD) in terms of the time required to complete the WMFT (MD = 0.44; 95%CI, -2.22 to 3.10, p = 0.75; I² = 55%, p = 0.06) and standard mean difference (SMD) in terms of the functional ability scores on the WMFT, ARAT and BBT (SMD = 0.25; 95%CI, -0.02 to 0.52, p = 0.07; I² = 54%, p = 0.02).

Discussion and implications

Compared to UULT, BULT yielded superior improvements in the improving motor impairment of people with stroke, as measured by the FMA-UE. However, these strategies did not yield significant differences in terms of the functional performance of people with stroke, as measured by the WMFT, ARAT and BBT. More comparative studies of the effects of BULT and UULT are needed to increase the reliability of these conclusions.

An Essential Role of the Intraparietal Sulcus in Response Inhibition Predicted by Parcellation-Based Network

The posterior parietal cortex (PPC) features close anatomical and functional relationships with the prefrontal cortex. However, the necessity of the PPC in executive functions has been questioned. The present study used the stop-signal task to examine response inhibition, an executive function that inhibits prepotent response tendency. The brain activity and resting-state functional connectivity were measured to analyze a parcellation-based network that was aimed at identifying a candidate PPC region essential for response inhibition in humans. The intraparietal sulcus (IPS) was activated during response inhibition and connected with the inferior frontal cortex and the presupplementary motor area, the two frontal regions known to be necessary for response inhibition. Next, transcranial magnetic stimulation (TMS) was used to test the essential role of the IPS region for response inhibition. TMS over the IPS region prolonged the stop-signal reaction time (SSRT), the standard behavioral index used to evaluate stopping performance, when stimulation was applied 30-0 ms before stopping. On the contrary, stimulation over the temporoparietal junction region, an area activated during response inhibition but lacking connectivity with the two frontal regions, did not show changes in SSRT. These results indicate that the IPS identified using the parcellation-based network plays an essential role in executive functions.SIGNIFICANCE STATEMENT Based on the previous neuropsychological studies reporting no impairment in executive functions after lesions in the posterior parietal cortex (PPC), the necessity of PPC in executive functions has been questioned. Here, contrary to the long-lasting view, by using recently developed analysis in functional MRI ("parcellation-based network analysis"), we identified the intraparietal sulcus (IPS) region in the PPC as essential for response inhibition: one executive function to stop actions that are inaccurate in a given context. The necessity of IPS for response inhibition was further tested by an interventional technique of transcranial magnetic stimulation. Stimulation to the IPS disrupted the performance of stopping. Our findings suggest that the IPS plays essential roles in executive functions.

Investigating the effect of anticipating a startling acoustic stimulus on preparatory inhibition

OBJECTIVES

Motor-evoked potentials (MEPs) to transcranial magnetic stimulation (TMS) show a profound suppression when elicited during the instructed-delay of reaction time (RT) tasks. One predominant hypothesis is that this phenomenon, called "preparatory inhibition", reflects the operation of processes that suppress motor activity to withhold prepared (but delayed) responses, a form of impulse control. In addition, a startling acoustic stimulus (SAS) - a loud and narrow sound - can trigger the release of prepared responses in RT tasks. We predicted that, if such premature release is clearly forbidden, then anticipating a SAS during delay periods may be associated with increased preparatory inhibition for greater impulse control.

METHODS

Subjects performed a behavioural (n=16) and TMS (n=11) experiment. Both used a choice RT task that required subjects to choose a response based on a preparatory cue but to only release it after an imperative signal. SAS and TMS pulses were elicited at the end of the delay period and subjects were asked to do their best to only release their response after the imperative signal, even in the presence of SAS. SAS could be either rare or frequent, in separate blocks.

RESULTS

Consistent with the literature, SAS shortened RTs, especially when they occurred frequently. Moreover, MEPs were suppressed when subjects delayed prepared responses but this preparatory inhibition did not depend on whether SAS were frequent or rare.

DISCUSSION

The stronger RT shortening with frequent rather than rare SAS may be due to increased attention and/or reduced reactive inhibition to SAS, leaving preparatory inhibition unaffected.

Interhermispheric inhibition predicts anxiety levels in multiple sclerosis: A corticospinal excitability study

BACKGROUND

Depression and anxiety stand among the most frequent and debilitating complaints in multiple sclerosis (MS) patients. Understanding their neurophysiological correlates might improve their management. To date, no single study has addressed this issue.

METHOD

Patients completed the Hospital Anxiety and Depression Scale (HADS). Transcranial magnetic stimulation (TMS) was performed to obtain the following corticospinal excitability measures: resting motor threshold, short-interval intracortical inhibition and facilitation, cortical silent period and interhemispheric inhibition (IHI). Anxiety and depression scores were the primary outcomes in the univariate analysis. When obtaining significant associations between anxiety/depression and TMS measures, a multivariate analysis was performed using stepwise linear regression with anxiety and depression scores employed separately as dependent variables and TMS measures, clinical and sociodemographic data as independent variables. Due to the small sample size and the large number of studied variables, only variables with p values <0.05 in the univariate analysis were included in the multivariate analysis.

RESULTS

Fifty patients completed the study (n = 24 women). Their mean age was 51.82 ± 12.72 years. Mean depression score was 6.08 ± 3.66. Mean anxiety score was 5.82 ± 3.42. A significant association was found between anxiety and IHI (p < 0.05), fatigue (p < 0.05), depression (p < 0.05), and female gender (p < 0.05). Stepwise linear regression analysis was performed and IHI values explained 9.10% of variance in anxiety levels (standardized β: 0.31; p < 0.01) when controlling for remaining variables. As for depression, it did not significantly correlate with any TMS measures.

CONCLUSION

The results highlight the relationship between anxiety and callosal transfer as reflected by IHI values. The current findings are consistent with previous works assessing healthy participants and patients with social anxiety disorders. Compared to MS patients with aberrant callosal transfer (suggested by low IHI values), those exhibiting a relatively more efficient one (reflected by high IHI values) seem to have higher anxiety scores, a finding that merits further assessment.

Using a Double-Coil TMS Protocol to Assess Preparatory Inhibition Bilaterally

Transcranial magnetic stimulation (TMS) applied over the primary motor cortex (M1), elicits motor-evoked potentials (MEPs) in contralateral limb muscles which are valuable indicators of corticospinal excitability (CSE) at the time of stimulation. So far, most studies have used single-coil TMS over one M1, yielding MEPs in muscles of a single limb-usually the hand. However, tracking CSE in the two hands simultaneously would be useful in many contexts. We recently showed that, in the resting state, double-coil stimulation of the two M1 with a 1 ms inter-pulse interval (double-coil_{1 ms} TMS) elicits MEPs in both hands that are comparable to MEPs obtained using single-coil TMS. To further evaluate this new technique, we considered the MEPs elicited by double-coil_{1 ms} TMS in an instructed-delay choice reaction time task where a prepared response has to be withheld until an imperative signal is displayed. Single-coil TMS studies have repetitively shown that in this type of task, the motor system is transiently inhibited during the delay period, as evident from the broad suppression of MEP amplitudes. Here, we aimed at investigating whether a comparable inhibitory effect can be observed with MEPs elicited using double-coil_{1 ms} TMS. To do so, we compared the amplitude as well as the coefficient of variation (CV) of MEPs produced by double-coil_{1 ms} or single-coil TMS during action preparation. We observed that MEPs were suppressed (smaller amplitude) and often less variable (smaller CV) during the delay period compared to baseline. Importantly, these effects were equivalent whether single-coil or double-coil_{1 ms} TMS was used. This suggests that double-coil_{1 ms} TMS is a reliable tool to assess CSE, not only when subjects are at rest, but also when they are involved in a task, opening new research horizons for scientists interested in the corticospinal correlates of human behavior.