The Hand Motor Hotspot is not Always Located in the Hand Knob: A Neuronavigated Transcranial Magnetic Stimulation Study

被引:49
作者
Ahdab, Rechdi [1 ,2 ,3 ]
Ayache, Samar S. [1 ,2 ,3 ]
Brugieres, Pierre [4 ]
Farhat, Wassim H. [1 ,2 ]
Lefaucheur, Jean-Pascal [1 ,2 ]
机构
[1] Univ Paris Est Creteil, Excitabilite Nerveuse & Therapeut, EA 4391, Creteil, France
[2] Hop Henri Mondor, AP HP, Serv Physiol Explorat Fonct, 51 Ave de Lattre de Tassigny, F-94010 Creteil, France
[3] Rizk Hosp, Div Neurol, Univ Med Ctr, Beirut, Lebanon
[4] Hop Henri Mondor, AP HP, Serv Neuroradiol, F-94010 Creteil, France
关键词
Motor cortex; Motor hotspot; Navigation; Sulcal anatomy; Transcranial magnetic stimulation; DIRECT CORTICAL STIMULATION; UPPER-LIMB MOTONEURONS; BRAIN-TUMOR SURGERY; FRONTAL-LOBE; CORTICOSPINAL PROJECTIONS; TOPOGRAPHIC ORGANIZATION; ELECTRICAL-STIMULATION; ANATOMICAL LANDMARKS; COIL PLACEMENT; NAVIGATED TMS;
D O I
10.1007/s10548-016-0486-2
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
The hand motor hot spot (hMHS) is one of the most salient parameters in transcranial magnetic stimulation (TMS) practice, notably used for targeting. It is commonly accepted that the hMHS corresponds to the hand representation within the primary motor cortex (M1). Anatomical and imaging studies locate this representation in a region of the central sulcus called the "hand knob". The aim of this study was to determine if the hMHS location corresponds to its expected location at the hand knob. Twelve healthy volunteers and eleven patients with chronic neuropathic pain of various origins, but not related to a brain lesion, were enrolled. Morphological magnetic resonance imaging of the brain was normal in all participants. Both hemispheres were studied in all participants except four (two patients and two healthy subjects). Cortical mapping of the hand motor area was conducted using a TMS-dedicated navigation system and recording motor evoked potentials (MEPs) in the contralateral first dorsal interosseous (FDI) muscle. We then determined the anatomical position of the hMHS, defined as the stimulation site providing the largest FDI-MEPs. In 45 % of hemispheres of normal subjects and 25 % of hemispheres of pain patients, the hMHS was located over the central sulcus, most frequently at the level of the hand knob. However, in the other cases, the hMHS was located outside M1, most frequently anteriorly over the precentral or middle frontal gyrus. This study shows that the hMHS does not always correspond to the hand knob and M1 location in healthy subjects or patients. Therefore, image-guided navigation is needed to improve the anatomical accuracy of TMS targeting, even for M1.
引用
收藏
页码:590 / 597
页数:8
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