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Preservation of motor maps with increased motor evoked potential amplitude threshold in RMT determination

  • Technical Note - Brain Tumors
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A Correction to this article was published on 16 June 2018

This article has been updated

Abstract

Objective

Non-invasive pre-surgical map** of eloquent brain areas with navigated transcranial magnetic stimulation (nTMS) is a useful technique linked to the improvement of surgical planning and patient outcomes. The stimulator output intensity and subsequent resting motor threshold determination (rMT) are based on the motor-evoked potential (MEP) elicited in the target muscle with an amplitude above a predetermined threshold of 50 μV. However, a subset of patients is unable to achieve complete relaxation in the target muscles, resulting in false positives that jeopardize map** validity with conventional MEP determination protocols. Our aim is to explore the feasibility and reproducibility of a novel map** approach that investigates how an increase of the MEP amplitude threshold to 300 and 500 μV affects subsequent motor maps.

Materials and methods

Seven healthy subjects underwent motor map** with nTMS. RMT was calculated with the conventional methodology in conjunction with experimental 300- and 500-μV MEP amplitude thresholds. Motor map** was performed with 105% of rMT stimulator intensity using the FDI as the target muscle.

Results

Motor map** was possible in all patients with both the conventional and experimental setups. Motor area maps with a conventional 50-μV threshold showed poor correlation with 300-μV (α = 0.446, p < 0.001) maps, but showed excellent consistency with 500-μV motor area maps (α = 0.974, p < 0.001). MEP latencies were significantly less variable (23 ms for 50 μV vs. 23.7 ms for 300 μV vs. 23.7 ms for 500 μV, p < 0.001). A slight but significant increase of the electric field (EF) value was found (EF: 60.8 V/m vs. 64.8 V/m vs. 66 V/m p < 0.001).

Conclusion

Our study demonstrates the feasibility of increasing the MEP detection threshold to 500 μV in rMT determination and motor area map** with nTMS without losing precision.

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Fig. 1

Change history

  • 16 June 2018

    Funding information is added.

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Acknowledgements

The research of Giuseppe Lucente is supported by a Rio Hortega contract (ISCIII CM16/00016 and FEDER).

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Authors and Affiliations

  1. Neuroscience Department, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain

    Giuseppe Lucente

  2. Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany

    Steven Lam, Heike Schneider & Thomas Picht

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  1. Giuseppe Lucente
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  2. Steven Lam
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Correspondence to Giuseppe Lucente.

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All procedures were performed in accordance with ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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TP has served as a speaker for NexStim Oy. GL, HS and SL declare that they have no affiliations with or involvement in any organization 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.

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Lucente, G., Lam, S., Schneider, H. et al. Preservation of motor maps with increased motor evoked potential amplitude threshold in RMT determination. Acta Neurochir 160, 325–330 (2018). https://doi.org/10.1007/s00701-017-3417-4

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