TMS motor mapping in brain tumor patients: more robust maps with an increased resting motor threshold.
Acta Neurochir (Wien) 2019;
161:995-1002. [PMID:
30927156 DOI:
10.1007/s00701-019-03883-8]
[Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/20/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE
Navigated transcranial magnetic stimulation (nTMS) has found widespread usage across many clinical centers as part of their surgical planning routines. NTMS offers a non-invasive approach to delineation of the motor cortex, in which the region is outlined through electromagnetic stimulation and electromyographic recordings of target muscles. Several neurophysiological parameters such as the motor evoked potential (MEP) and its derivatives, the resting motor threshold (RMT) and motor latency, are collected. The present study investigates the clinical feasibility and reproducibility of increasing the MEP threshold in brain tumor patients, with the goal to improve the robustness of the procedure.
MATERIALS AND METHODS
Twenty-three subjects with peri-motor cortex tumors underwent motor mapping with nTMS. RMT was calculated with both conventional 50-μV and experimental 500-μV MEP amplitude thresholds. Motor mapping was performed with 105% of both RMTs stimulator intensity using the FDI as the target muscle.
RESULTS
Motor mapping was possible in 20 patients with both the conventional and experimental thresholds. No significant differences in area size were found between motor area maps generated with a conventional 50-μV threshold in comparison to those generated with the higher 500-μV threshold (50 μV 272.56 mm2 [170.47-434.31] vs. 500 μV 240.54 mm2 [169.77-362.84], P = 0.34). Latency time was significantly reduced in 500-μV recordings relative to 50-μV recordings (50 μV 23.38 ms [22.55-24.51] vs. 500 μV 22.57 ms [21.41-23.70], P < 0.001). Both electric field intensity (50 μV 63.81 V/m [54.26-76.11] vs. 500 μV 77.83 V/m [65.21-93.94], P < 0.001) and RMT (50 μV 33 MSO% [28-36] vs. 500 μV 39.5 MSO% [32-44], P < 0.001) were significantly greater with the higher 500-μV threshold.
CONCLUSIONS
Our study demonstrates the feasibility of increasing the MEP detection threshold to 500 μV in brain tumor patients for RMT determination and motor area mapping with nTMS.
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