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Open Access 01-02-2010 | Experimental Research

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

Authors: Sven Rainer Kantelhardt, Tommaso Fadini, Markus Finke, Kai Kallenberg, Jakob Siemerkus, Volker Bockermann, Lars Matthaeus, Walter Paulus, Achim Schweikard, Veit Rohde, Alf Giese

Published in: Acta Neurochirurgica | Issue 2/2010

Abstract

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.

Missir O, Dutheil-Desclercs C, Meder JF, Musolino A, Fredy D (1989) Central sulcus patterns at MRI. J Neuroradiol 16(2):133–144PubMed

Penfield W, Boldry E (1937) Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain 60:389–443CrossRef

Lehéricy S, Duffau H, Cornu P, Capelle L, Pidoux B, Carpentier A, Auliac S, Clemenceau S, Sichez JP, Bitar A, Valery CA, Van Effenterre R, Faillot T, Srour A, Fohanno D, Philippon J, Le Bihan D, Marsault C (2000) Correspondence between functional magnetic resonance imaging somatotopy and individual brain anatomy of the central region: comparison with intraoperative stimulation in patients with brain tumors. J Neurosurg 92(4):589–598CrossRefPubMed

Sala F, Lanteri P (2003) Brain surgery in motor areas: the invaluable assistance of intraoperative neurophysiological monitoring. J Neurosurg Sci 47(2):79–88PubMed

Frahm J, Bruhn H, Merboldt KD, Hänicke W (1992) Dynamic MR imaging of human brain oxygenation during rest and photic stimulation. J Magn Reson Imaging 2(5):501–505CrossRefPubMed

Rao SM, Binder JR, Hammeke TA, Bandettini PA, Bobholz JA, Frost JA, Myklebust BM, Jacobson RD, Hyde JS (1995) Somatotopic mapping of the human primary motor cortex with functional magnetic resonance imaging. Neurology 45(5):919–924PubMed

Bizzi A, Blasi V, Falini A, Ferroli P, Cadioli M, Danesi U, Aquino D, Marras C, Caldiroli D, Broggi G (2008) Presurgical functional MR imaging of language and motor functions: validation with intraoperative electrocortical mapping. Radiology 248(2):579–589CrossRefPubMed

Fandino J, Kollias SS, Wieser HG, Valavanis A, Yonekawa Y (1999) Intraoperative validation of functional magnetic resonance imaging and cortical reorganization patterns in patients with brain tumors involving the primary motor cortex. J Neurosurg 91(2):238–250CrossRefPubMed

Mueller WM, Yetkin FZ, Hammeke TA, Morris GL 3rd, Swanson SJ, Reichert K, Cox R, Haughton VM (1996) Functional magnetic resonance imaging mapping of the motor cortex in patients with cerebral tumors. Neurosurgery 39(3):515–520CrossRefPubMed

10.

Grafton ST, Woods RP, Mazziotta JC, Phelps ME (1991) Somatotopic mapping of the primary motor cortex in humans: activation studies with cerebral blood flow and positron emission tomography. J Neurophysiol 66(3):735–743PubMed

11.

Viñas FC, Zamorano L, Mueller RA, Jiang Z, Chugani H, Fuerst D, Muzik O, Mangner TJ, Diaz FG (1997) [15O]-water PET and intraoperative brain mapping: a comparison in the localization of eloquent cortex. Neurol Res 19(6):601–608PubMed

12.

Cheyne D, Kristeva R, Deecke L (1991) Homuncular organization of human motor cortex as indicated by neuromagnetic recordings. Neurosci Lett 122(1):17–20CrossRefPubMed

13.

Lotze M, Kaethner RJ, Erb M, Cohen LG, Grodd W, Topka H (2003) Comparison of representational maps using functional magnetic resonance imaging and transcranial magnetic stimulation. Clin Neurophysiol 114(2):306–312CrossRefPubMed

14.

Krings T, Buchbinder BR, Butler WE, Chiappa KH, Jiang HJ, Rosen BR, Cosgrove GR (1997) Stereotactic transcranial magnetic stimulation: correlation with direct electrical cortical stimulation. Neurosurgery 41(6):1319–1325CrossRefPubMed

15.

Neggers SF, Langerak TR, Schutter DJ, Mandl RC, Ramsey NF, Lemmens PJ, Postma A (2004) A stereotactic method for image-guided transcranial magnetic stimulation validated with fMRI and motor-evoked potentials. Neuroimage 21(4):1805–1817CrossRefPubMed

16.

Sparing R, Buelte D, Meister IG, Paus T, Fink GR (2008) Transcranial magnetic stimulation and the challenge of coil placement: a comparison of conventional and stereotaxic neuronavigational strategies. Hum Brain Mapp 29(1):82–96CrossRefPubMed

17.

Denslow S, Bohning DE, Bohning PA, Lomarev MP, George MS (2005) An increased precision comparison of TMS-induced motor cortex BOLD fMRI response for image-guided versus function-guided coil placement. Cogn Behav Neurol 18(2):119–126CrossRefPubMed

18.

Matthäus L, Trillenberg P, Bodensteiner C, Giese A, Schweikard A (2006) Robotized TMS for motion compensated navigated brain stimulation. Presented at the 20th International Computer Assisted Radiology and Surgery Congress, Osaka, Japan, June 28–July 1.

19.

Horn B (1987) Closed-form solution of absolute orientation using unit quaternions. J Opt Soc Am A 4(4):629–642CrossRef

20.

Noirhomme Q, Ferrant M, Vandermeeren Y, Olivier E, Macq B, Cuisenaire O (2004) Registration and real-time visualization of transcranial magnetic stimulation with 3-d MR images. IEEE T Biomed E 51(11):1994–2005CrossRef

21.

Matthäus L, Giese A, Wertheimer D, Schweikard A (2006) Planning and analyzing robotized TMS using virtual reality. Stud Health Technol Inform 119:373–378PubMed

22.

Matthäus L, Trillenberg P, Fadini T, Finke M, Schweikard A (2008) Brain mapping with transcranial magnetic stimulation using a refined correlation ratio and Kendall’s tau. Stat Med 27(25):5252–5270CrossRefPubMed

23.

Gumprecht H, Widenka D, Lumenta C (1999) BrainLab vectorvision neuronavigation system: technology and clinical experiences in 131 cases. Neurosurgery 44(1):97–104CrossRefPubMed

24.

Kammer T, Beck S, Thielscher A, Laubis-Herrmann U, Topka H (2001) Motor thresholds in humans: a transcranial magnetic stimulation study comparing different pulse waveforms, current directions and stimulator types. Clin Neurophysiol 112(2):250–258CrossRefPubMed

25.

Krings T, Buchbinder BR, Butler WE, Chiappa KH, Jiang HJ, Cosgrove GR, Rosen BR (1997) Functional magnetic resonance imaging and transcranial magnetic stimulation: complementary approaches in the evaluation of cortical motor function. Neurology 48(5):1406–1416PubMed

26.

Macdonell RA, Jackson GD, Curatolo JM, Abbott DF, Berkovic SF, Carey LM, Syngeniotin A, Fabinyi GC, Scheffer IE (1999) Motor cortex localization using functional MRI and transcranial magnetic stimulation. Neurology 53(7):1462–1467PubMed

27.

Niyazov DM, Butler AJ, Kadah YM, Epstein CM, Hu XP (2005) Functional magnetic resonance imaging and transcranial magnetic stimulation: effects of motor imagery, movement and coil orientation. Clin Neurophysiol 116(7):1601–1610CrossRefPubMed

28.

Rathelot JA, Strick PL (2006) Muscle representation in the macaque motor cortex: an anatomical perspective. Proc Natl Acad Sci USA 103(21):8257–8262CrossRefPubMed

29.

Teitti S, Määttä S, Säisänen L, Könönen M, Vanninen R, Hannula H, Mervaala E, Karhu J (2008) Non-primary motor areas in the human frontal lobe are connected directly to hand muscles. Neuroimage 40(3):1243–1250CrossRefPubMed

30.

Epstein CM, Meador KJ, Loring DW, Wright RJ, Weissman JD, Sheppard S, Lah JJ, Puhalovich F, Gaitan L, Davey KR (1999) Localization and characterization of speech arrest during transcranial magnetic stimulation. Clin Neurophysiol 110(6):1073–1079CrossRefPubMed

31.

Roux FE, Boulanouar K, Lotterie JA, Mejdoubi M, LeSage JP, Berry I (2003) Language functional magnetic resonance imaging in preoperative assessment of language areas: correlation with direct cortical stimulation. Neurosurgery 52(6):1335–1345CrossRefPubMed

32.

Seyal M, Masuoka LK, Browne JK (1992) Suppression of cutaneous perception by magnetic pulse stimulation of the human brain. Electroencephalogr Clin Neurophysiol 85(6):397–401CrossRefPubMed

33.

Amassian VE, Cracco RQ, Maccabee PJ, Cracco JB, Rudell A, Eberle L (1989) Suppression of visual perception by magnetic coil stimulation of human occipital cortex. Electroencephalogr Clin Neurophysiol 74(6):458–462CrossRefPubMed

34.

Corthout E, Hallett M, Cowey A (2003) Interference with vision by TMS over the occipital pole: a fourth period. NeuroReport 14(4):651–565CrossRefPubMed

35.

Pascual-Leone A, Gates JR, Dhuna A (1991) Induction of speech arrest and counting errors with rapid-rate transcranial magnetic stimulation. Neurology 41(5):697–702PubMed

36.

Borckardt JJ, Smith AR, Reeves ST, Weinstein M, Kozel FA, Nahas Z, Shelley N, Branham RK, Thomas KJ, George MS (2007) Fifteen minutes of left prefrontal repetitive transcranial magnetic stimulation acutely increases thermal pain thresholds in healthy adults. Pain Res Manag 12(4):287–290PubMed

37.

Dell’Osso B, Mundo E, D’Urso N, Pozzoli S, Buoli M, Ciabatti M, Rosanova M, Massimini M, Bellina V, Mariotti M, Carlo Altamura A (2009) Augmentative repetitive navigated transcranial magnetic stimulation (rTMS) in drug-resistant bipolar depression. Bipolar Disord 11(1):76–81CrossRefPubMed

Title: Robot-assisted image-guided transcranial magnetic stimulation for somatotopic mapping of the motor cortex: a clinical pilot study
Authors: Sven Rainer Kantelhardt
Tommaso Fadini
Markus Finke
Kai Kallenberg
Jakob Siemerkus
Volker Bockermann
Lars Matthaeus
Walter Paulus
Achim Schweikard
Veit Rohde
Alf Giese
Publication date: 01-02-2010
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 2/2010
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-009-0565-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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