Optimum stimulus parameters for lateralized suppression of speech with magnetic brain stimulation

Epstein, Charles M.; Lah, James J.; Meador, Kimford J.; Weissman, Joseph D.; Gaitan, Luis E.; Dihenia, B.

doi:10.1212/wnl.47.6.1590

Cited by 169 publications

(127 citation statements)

References 4 publications

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“…17,24 In contrast, rTMS mapping shows the effect of a temporary functional lesion in the depolarization and therefore inactivation of a designated brain region and the whole connected functional network. 14,19,47,79,81 A recently reported case showed fMRI and rTMS yielding contrary results, but the use of our protocols would make it possible to combine lesion-based and blood flow-based techniques even in this case. 68 That these 2 principles can complement each other has already been shown in previous studies.…”

Section: Discussion Rtms Versus Dcs Language Mappingmentioning

confidence: 92%

“…Nevertheless, both techniques operate on the same theory-the "virtual lesion"-and rTMS has already proved effective concerning language tasks. 14,19,78,81 In other words, rTMS language mapping is already feasible, but there are some differences regarding the comparison with DCS language mapping. Furthermore, the classic distribution of human language function to Broca's and Wernicke's areas is no longer current, and it is even not definitely resolved how essential these 2 regions are.…”

Section: Discussion Rtms Versus Dcs Language Mappingmentioning

confidence: 99%

“…22,33,35,52,53,77 Furthermore, repetitive navigated TMS (rTMS) and nonnavigated TMS are able to localize cortical language function. 18,19,40,48,69,80 Its clinical applicability and correlation to DCS during awake surgery have repeatedly been shown as well. 36,37,51,68,75 Although rTMS language mapping has already experienced some improvement, 40 the standard for preoperative, noninvasive language mapping remains functional MRI (fMRI).…”

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confidence: 93%

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Combined noninvasive language mapping by navigated transcranial magnetic stimulation and functional MRI and its comparison with direct cortical stimulation

Ille

Sollmann

Hauck

et al. 2015

JNS

100

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T he resection of tumors within or adjacent to language-eloquent brain regions is still a neurosurgical quest, and a profound presurgical workup is crucial to achieving the best functional and oncological result. 6,71 Today, the most precise way to localize individual language-eloquent regions is direct cortical stimulation (DCS) during awake craniotomy. 9,12,26,44,45,54,62,65,74 Using only DCS, however, we cannot provide the longitudinal abbreviatioNs BOLD = blood oxygen level-dependent; CPS = cortical parcellation system; DCS direct cortical stimulation; ER = error rate; ERT error rate threshold; fMRI = functional MRI; IPI = interpicture interval; NPV = negative predictive value; nTMS navigated TMS; PPV = positive predictive value; PTI = picture-to-trigger interval; RMT = resting motor threshold; ROC = receiver operating characteristic; rTMS repetitive navigated TMS; TMS = transcranial magnetic stimulation. obJect Repetitive navigated transcranial magnetic stimulation (rTMS) is now increasingly used for preoperative language mapping in patients with lesions in language-related areas of the brain. Yet its correlation with intraoperative direct cortical stimulation (DCS) has to be improved. To increase rTMS's specificity and positive predictive value, the authors aim to provide thresholds for rTMS's positive language areas. Moreover, they propose a protocol for combining rTMS with functional MRI (fMRI) to combine the strength of both methods. methods The authors performed multimodal language mapping in 35 patients with left-sided perisylvian lesions by using rTMS, fMRI, and DCS. The rTMS mappings were conducted with a picture-to-trigger interval (PTI, time between stimulus presentation and stimulation onset) of either 0 or 300 msec. The error rates (ERs; that is, the number of errors per number of stimulations) were calculated for each region of the cortical parcellation system (CPS). Subsequently, the rTMS mappings were analyzed through different error rate thresholds (ERT; that is, the ER at which a CPS region was defined as language positive in terms of rTMS), and the 2-out-of-3 rule (a stimulation site was defined as language positive in terms of rTMS if at least 2 out of 3 stimulations caused an error). As a second step, the authors combined the results of fMRI and rTMS in a predefined protocol of combined noninvasive mapping. To validate this noninvasive protocol, they correlated its results to DCS during awake surgery. results The analysis by different rTMS ERTs obtained the highest correlation regarding sensitivity and a low rate of false positives for the ERTs of 15%, 20%, 25%, and the 2-out-of-3 rule. However, when comparing the combined fMRI and rTMS results with DCS, the authors observed an overall specificity of 83%, a positive predictive value of 51%, a sensitivity of 98%, and a negative predictive value of 95%. coNclusioNs In comparison with fMRI, rTMS is a more sensitive but less specific tool for preoperative language mapping than DCS. Moreover, rTMS is most reliable when using ERTs of 15%, 20...

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Section: Discussion Rtms Versus Dcs Language Mappingmentioning

confidence: 92%

Section: Discussion Rtms Versus Dcs Language Mappingmentioning

confidence: 99%

mentioning

confidence: 93%

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Combined noninvasive language mapping by navigated transcranial magnetic stimulation and functional MRI and its comparison with direct cortical stimulation

Ille

Sollmann

Hauck

et al. 2015

JNS

100

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“…In the latter case, we could avoid the interference of pain or discomfort with the consecutive-response evaluation; hence, we even lowered the stimulation intensity if 100% RMT was painful. 15 This was necessary in 2 patients (7%).…”

Section: Methodsmentioning

confidence: 99%

Impairment of preoperative language mapping by lesion location: a functional magnetic resonance imaging, navigated transcranial magnetic stimulation, and direct cortical stimulation study

Ille¹,

Sollmann²,

Hauck³

et al. 2015

JNS

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Since transcranial magnetic stimulation (TMS) was introduced for stimulating the human motor cortex by Barker et al. in 1985, the method has become more sophisticated and was extensively refined.1 PascualLeone and colleagues introduced the term "virtual lesion" and were already in 1991 able to induce speech arrests and counting errors by the use of rapid-rate TMS. 35,36 In the late 1990s and early 2000s, a combination of TMS with optically tracked stereotactic navigation systems was established, whereby it was possible to visualize the stimulation sites via the 3D reconstructed MRI data of the patient's brain. 31,37 Thus, the door to the operating theater was opened since the recorded and analyzed stimulation sites could be used for presurgical planning and data could be abbreviatioNs BOLD = blood-oxygen-level dependent; CPS = cortical parcellation system; DCS = direct cortical stimulation; DTI-FT = diffusion tensor imaging fiber tracking; fMRI = functional MRI; NPV = negative predictive value; PPV = positive predictive value; PTI = picture-to-trigger interval; RMT = resting motor threshold; ROC = receiver operating characteristic; rTMS = repetitive navigated TMS; TMS = transcranial magnetic stimulation. (rTMS) is increasingly used and has already replaced functional MRI (fMRI) in some institutions for preoperative mapping of neurosurgical patients. Yet some factors affect the concordance of both methods with direct cortical stimulation (DCS), most likely by lesions affecting cortical oxygenation levels. Therefore, the impairment of the accuracy of rTMS and fMRI was analyzed and compared with DCS during awake surgery in patients with intraparenchymal lesions. methods Language mapping was performed by DCS, rTMS, and fMRI using an object-naming task in 27 patients with left-sided perisylvian lesions, and the induced language errors of each method were assigned to the cortical parcellation system. Subsequently, the receiver operating characteristics were calculated for rTMS and fMRI and compared with DCS as ground truth for regions with (w/) and without (w/o) the lesion in the mapped regions. results The w/ subgroup revealed a sensitivity of 100% (w/o 100%), a specificity of 8% (w/o 5%), a positive predictive value of 34% (w/o: 53%), and a negative predictive value (NPV) of 100% (w/o: 100%) for the comparison of rTMS versus DCS. Findings for the comparison of fMRI versus DCS within the w/ subgroup revealed a sensitivity of 32% (w/o: 62%), a specificity of 88% (w/o: 60%), a positive predictive value of 56% (w/o: 62%), and a NPV of 73% (w/o: 60%). coNclusioNs Although strengths and weaknesses exist for both rTMS and fMRI, the results show that rTMS is less affected by a brain lesion than fMRI, especially when performing mapping of language-negative cortical regions based on sensitivity and NPV.

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“…Conversely, higher frequency stimulation is behaviorally excitatory . However, high-frequency TMS over some brain regions can temporarily block or knockout the function of that part of the brain (Epstein et al, 1996;Pascual-Leone et al, 1991).…”

Section: Description Of Methodsmentioning

confidence: 99%

Noninvasive techniques for probing neurocircuitry and treating illness: vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS)

George

Aston‐Jones

2009

Neuropsychopharmacol

319

205

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Although the preceding chapters discuss much of the new knowledge of neurocircuitry of neuropsychiatric diseases, and an invasive approach to treatment, this chapter describes and reviews the noninvasive methods of testing circuit-based theories and treating neuropsychiatric diseases that do not involve implanting electrodes into the brain or on its surface. These techniques are transcranial magnetic stimulation, vagus nerve stimulation, and transcranial direct current stimulation. Two of these approaches have FDA approval as therapies.

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Optimum stimulus parameters for lateralized suppression of speech with magnetic brain stimulation

Cited by 169 publications

References 4 publications

Combined noninvasive language mapping by navigated transcranial magnetic stimulation and functional MRI and its comparison with direct cortical stimulation

Combined noninvasive language mapping by navigated transcranial magnetic stimulation and functional MRI and its comparison with direct cortical stimulation

Impairment of preoperative language mapping by lesion location: a functional magnetic resonance imaging, navigated transcranial magnetic stimulation, and direct cortical stimulation study

Noninvasive techniques for probing neurocircuitry and treating illness: vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS)

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