Functional plasticity of the motor cortical structures demonstrated by navigated TMS in two patients with epilepsy

Tutkimustuotos: ArtikkelijulkaisuArtikkeliTieteellinenvertaisarvioitu

Kuvaus

Background: Recently, navigated transcranial magnetic stimulation (nTMS) has been suggested to be useful in preoperative functional localization of motor cortex in patients having tumors close to the somatomotor cortex. Resection of tumors in anatomically predicted eloquent areas without adverse effects have emphasized functional plasticity elicited by intracranial pathology.
Objective: To describe functional plasticity of motor cortex indicated by nTMS in two patients with epilepsy.
Methods: nTMS, functional MRI (fMRI), diffusion-tensor tractography and magnetoencephalography (MEG) were utilized to preoperatively localize motor cortical areas in the workup for epilepsy surgery. The localizations were compared with each other, with the cortical anatomical landmarks, and in one
patient with invasive electrical cortical stimulation (ECS).
Results: In two out of 19 studied patients, nTMS identified motor cortical sites that differed from those indicated by anatomical landmarks. In one patient, nTMS activated preferentially premotor cortex rather than pathways originating from the precentral gyrus. MEG and fMRI localizations conformed with nTMS whereas ECS localized finger motor function into the precentral gyrus. Resection of the area producing motor responses in biphasic nTMS did not produce a motor deficit. In the other patient, nTMS indicated abnormal ipsilateral hand motor cortex localization and confirmed the functionality of aberrant motor cortical representations of the left foot also indicated by fMRI and DT-tractography.
Conclusion: nTMS may reveal the functional plasticity and of motor cortical function. Epileptic foci may modify cortical inhibition and the nTMS results. Therefore, in some patients with epilepsy, the nTMS results need to be interpreted with caution with regard to surgical planning.

Alkuperäiskielienglanti
LehtiBrain Stimulation
Vuosikerta6
Sivut286-291
Sivumäärä5
ISSN1935-861X
DOI - pysyväislinkit
TilaJulkaistu - 2013
OKM-julkaisutyyppiA1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä, vertaisarvioitu

Tieteenalat

  • 3111 Biolääketieteet
  • 3124 Neurologia ja psykiatria

Lainaa tätä

@article{816575dd09d04352a3daa0231b62de1d,
title = "Functional plasticity of the motor cortical structures demonstrated by navigated TMS in two patients with epilepsy",
abstract = "Background: Recently, navigated transcranial magnetic stimulation (nTMS) has been suggested to be useful in preoperative functional localization of motor cortex in patients having tumors close to the somatomotor cortex. Resection of tumors in anatomically predicted eloquent areas without adverse effects have emphasized functional plasticity elicited by intracranial pathology. Objective: To describe functional plasticity of motor cortex indicated by nTMS in two patients with epilepsy. Methods: nTMS, functional MRI (fMRI), diffusion-tensor tractography and magnetoencephalography (MEG) were utilized to preoperatively localize motor cortical areas in the workup for epilepsy surgery. The localizations were compared with each other, with the cortical anatomical landmarks, and in one patient with invasive electrical cortical stimulation (ECS). Results: In two out of 19 studied patients, nTMS identified motor cortical sites that differed from those indicated by anatomical landmarks. In one patient, nTMS activated preferentially premotor cortex rather than pathways originating from the precentral gyrus. MEG and fMRI localizations conformed with nTMS whereas ECS localized finger motor function into the precentral gyrus. Resection of the area producing motor responses in biphasic nTMS did not produce a motor deficit. In the other patient, nTMS indicated abnormal ipsilateral hand motor cortex localization and confirmed the functionality of aberrant motor cortical representations of the left foot also indicated by fMRI and DT-tractography. Conclusion: nTMS may reveal the functional plasticity and of motor cortical function. Epileptic foci may modify cortical inhibition and the nTMS results. Therefore, in some patients with epilepsy, the nTMS results need to be interpreted with caution with regard to surgical planning.",
keywords = "3111 Biomedicine, 3124 Neurology and psychiatry",
author = "Jyrki M{\"a}kel{\"a} and Anne-Mari Vitikainen and Pantelis Lioumis and Ritva Paetau and Eero Ahtola and Linda Kuusela and Leena Valanne and Blomstedt, {G{\"o}ran Christian} and Eija Gaily",
year = "2013",
doi = "10.1016/j.brs.2012.04.012",
language = "English",
volume = "6",
pages = "286--291",
journal = "Brain Stimulation",
issn = "1935-861X",
publisher = "EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC",

}

TY - JOUR

T1 - Functional plasticity of the motor cortical structures demonstrated by navigated TMS in two patients with epilepsy

AU - Mäkelä, Jyrki

AU - Vitikainen, Anne-Mari

AU - Lioumis , Pantelis

AU - Paetau, Ritva

AU - Ahtola, Eero

AU - Kuusela, Linda

AU - Valanne, Leena

AU - Blomstedt, Göran Christian

AU - Gaily, Eija

PY - 2013

Y1 - 2013

N2 - Background: Recently, navigated transcranial magnetic stimulation (nTMS) has been suggested to be useful in preoperative functional localization of motor cortex in patients having tumors close to the somatomotor cortex. Resection of tumors in anatomically predicted eloquent areas without adverse effects have emphasized functional plasticity elicited by intracranial pathology. Objective: To describe functional plasticity of motor cortex indicated by nTMS in two patients with epilepsy. Methods: nTMS, functional MRI (fMRI), diffusion-tensor tractography and magnetoencephalography (MEG) were utilized to preoperatively localize motor cortical areas in the workup for epilepsy surgery. The localizations were compared with each other, with the cortical anatomical landmarks, and in one patient with invasive electrical cortical stimulation (ECS). Results: In two out of 19 studied patients, nTMS identified motor cortical sites that differed from those indicated by anatomical landmarks. In one patient, nTMS activated preferentially premotor cortex rather than pathways originating from the precentral gyrus. MEG and fMRI localizations conformed with nTMS whereas ECS localized finger motor function into the precentral gyrus. Resection of the area producing motor responses in biphasic nTMS did not produce a motor deficit. In the other patient, nTMS indicated abnormal ipsilateral hand motor cortex localization and confirmed the functionality of aberrant motor cortical representations of the left foot also indicated by fMRI and DT-tractography. Conclusion: nTMS may reveal the functional plasticity and of motor cortical function. Epileptic foci may modify cortical inhibition and the nTMS results. Therefore, in some patients with epilepsy, the nTMS results need to be interpreted with caution with regard to surgical planning.

AB - Background: Recently, navigated transcranial magnetic stimulation (nTMS) has been suggested to be useful in preoperative functional localization of motor cortex in patients having tumors close to the somatomotor cortex. Resection of tumors in anatomically predicted eloquent areas without adverse effects have emphasized functional plasticity elicited by intracranial pathology. Objective: To describe functional plasticity of motor cortex indicated by nTMS in two patients with epilepsy. Methods: nTMS, functional MRI (fMRI), diffusion-tensor tractography and magnetoencephalography (MEG) were utilized to preoperatively localize motor cortical areas in the workup for epilepsy surgery. The localizations were compared with each other, with the cortical anatomical landmarks, and in one patient with invasive electrical cortical stimulation (ECS). Results: In two out of 19 studied patients, nTMS identified motor cortical sites that differed from those indicated by anatomical landmarks. In one patient, nTMS activated preferentially premotor cortex rather than pathways originating from the precentral gyrus. MEG and fMRI localizations conformed with nTMS whereas ECS localized finger motor function into the precentral gyrus. Resection of the area producing motor responses in biphasic nTMS did not produce a motor deficit. In the other patient, nTMS indicated abnormal ipsilateral hand motor cortex localization and confirmed the functionality of aberrant motor cortical representations of the left foot also indicated by fMRI and DT-tractography. Conclusion: nTMS may reveal the functional plasticity and of motor cortical function. Epileptic foci may modify cortical inhibition and the nTMS results. Therefore, in some patients with epilepsy, the nTMS results need to be interpreted with caution with regard to surgical planning.

KW - 3111 Biomedicine

KW - 3124 Neurology and psychiatry

U2 - 10.1016/j.brs.2012.04.012

DO - 10.1016/j.brs.2012.04.012

M3 - Article

VL - 6

SP - 286

EP - 291

JO - Brain Stimulation

JF - Brain Stimulation

SN - 1935-861X

ER -