NTMS mapping of non-primary motor areas in brain tumour patients and healthy volunteers
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Navigated transcranial magnetic stimulation (nTMS) has been increasingly used for presurgical cortical mapping of the primary motor cortex (M1) but remains controversial for the evaluation of non-primary motor areas (NPMA). This study investigates clinical and neurophysiological parameters in brain tumour patients and healthy volunteers to decide whether single-pulse biphasic nTMS allows to reliably elicite MEP outside from M1 or not.
Materials and methods
Twelve brain tumour patients and six healthy volunteers underwent M1 nTMS mapping. NPMA nTMS mapping followed using 120% and 150% M1 resting motor threshold (RMT) stimulation intensity. Spearman’s correlation analysis tested the association of clinical and neurophysiological parameters between M1 and NPMA mapping.
A total of 88.81% of nTMS stimulations in NPMA in patients/83.87% in healthy volunteers in patients/83.87% in healthy volunteers did not result in MEPs ≥ 50 μV. Positive nTMS mapping in NPMA correlated with higher stimulation intensity and larger M1 areas in patients (120% M1 RMT SI p = 0.005/150% M1 RMT SI p = 0.198).
Our findings indicate that in case of positive nTMS mapping in NPMA, MEPs originate mostly from M1. For future studies, MEP parameters and TMS coil rotation should be studied closely to assess the risk for postoperative motor deterioration.
KeywordsElectric field M1 MEP NPMA nTMS
First dorsal interosseous muscle
Karnofsky Performance Status Scale
Motor evoked potentials
Medical Research Council
Primary motor cortex
Nine-Hole Peg Test
Non-primary motor areas
Navigated transcranial magnetic stimulation
Resting motor threshold
Supplementary motor area
Matters of Activity. Image Space Material. An Interdisciplinary Laboratory Cluster of Excellence at the Humboldt-Universität zu Berlin (sponsor number EXC 2025/1) with financial support from the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) supported the research. The sponsor had no role in the design or conduct of this research.
Compliance with ethical standards
Data collection was conducted in accordance with the ethical standards set forth by the ethics commission of the Charité University Hospital in Berlin (EA 2/135/14), local ethics committees, and the Declaration of Helsinki.
Conflict of interest
Thomas Picht has served as a speaker for a TMS manufacturer (Nexstim Oy) but is not a contracted consultant. All other authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Commission of the Charité University Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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