No abstract

Background: The precise cortical origins of the electrophysiological and behavioral effects of transcranial magnetic stimulation (TMS) remain largely unclear. Addressing this question is further impeded by substantial inter-individual response variability to TMS. Objective: We present a novel method to reliably and user-independently determine the effectively stimulated cortical site at the individual subject level. This generic approach combines physiological measurements with electric field simulations and leverages information from random coil positions, electric field estimations, and electromyography. Methods: We applied ~1000 single biphasic TMS pulses with standard TMS hardware to 13 subjects with random coil positions & orientations over the primary motor hand area. Motor evoked potentials (MEPs) of three finger muscles were recorded concurrently. We calculated the corresponding electric fields for all TMS pulses and regressed them against the elicited MEPs in each cortical element. This yields a cortical map of congruency between induced field strength and generated response. Results: We observed high congruence between the electric fields and the elicited MEPs in hotspots located primarily on the crowns and rims of the precentral gyrus. The three cortical digit representations could be distinguished at the individual subject level with a high spatial resolution. A post-hoc convergence analysis revealed a possible lower bound of only 180 pulses to obtain qualitatively identical results. Conclusions: Leveraging information from many different TMS pulses significantly reduces the number of necessary stimulations and mapping time. The protocol is easy to implement due to the realization of arbitrary coil positions & orientations and is suitable for practical and clinical use such as preoperative mapping.