Navigated TMS mapping using the grid-based algorithm to evaluate the reorganization of cortical muscle representation in amyotrophic lateral sclerosis

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Abstract

Introduction. Motor cortex mapping using navigated transcranial magnetic stimulation (TMS) is a promising method for assessing motor cortex reorganization in amyotrophic lateral sclerosis (ALS). The use of the grid-based algorithm allows the mapping protocol to be standardized and can help to reduce the variability of the assessed parameters.

Study aim — to analyse the reorganization features of the cortical representations of hand muscles in patients with classical ALS using navigated TMS mapping with a grid-based algorithm.

Materials and methods. The study included 14 patients with classical ALS and 9 healthy volunteers. Navigated TMS mapping of the cortical representations of the right abductor pollicis brevis (APB) muscle was performed using a predetermined grid (7×7 square cells) centred around a ‘hot spot’. Five stimuli with an intensity of 110% of the individual resting motor threshold (RMT) were randomly applied to each cell. The RMT and area of cortical representation of the APB muscle were analysed, amplitude or probability weighted.

Results. Patients with ALS showed a statistically significant decrease in the weighted amplitude of the area of cortical representations of the APB muscle compared with healthy volunteers. The RMT, area and weighted probability area of the cortical representations of the APB muscle did not differ significantly between the groups. A statistically significant correlation between RMT and severity of dysfunction and upper motor neuron damage was found in patients with ALS, based on the clinical data. There were no statistically significant correlations between cortical representation parameters and the clinical symptoms in patients with ALS.

Conclusion. Navigated TMS mapping of the motor cortex with a grid-based algorithm in patients with ALS revealed a decrease in the weighted amplitude of the cortical representation area of the APB muscle. It is important to clarify the role of navigated TMS mapping with the proposed algorithm in the diagnosis, prognosis and monitoring of ALS.

About the authors

Ilya S. Bakulin

Research Center of Neurology

Author for correspondence.
Email: bakulin@neurology.ru
ORCID iD: 0000-0003-0716-3737

Cand. Sci. (Med.), researcher, Department of neurorehabilitation and physiotherapy

Russian Federation, Moscow

Dmitry O. Sinitsyn

Research Center of Neurology

Email: bakulin@neurology.ru
Russian Federation, Moscow

Alexandra G. Poydasheva

Research Center of Neurology

Email: bakulin@neurology.ru
Russian Federation, Moscow

Andrey Yu. Chernyavskiy

Research Center of Neurology; K.A. Valiev Institute of Physics and Technology of the Russian Academy of Sciences

Email: bakulin@neurology.ru
Russian Federation, Moscow

Natalia A. Suponeva

Research Center of Neurology

Email: bakulin@neurology.ru
Russian Federation, Moscow

Maria N. Zakharova

Research Center of Neurology

Email: bakulin@neurology.ru
Russian Federation, Moscow

Mikhail A. Piradov

Research Center of Neurology

Email: bakulin@neurology.ru
Russian Federation, Moscow

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Copyright (c) 2019 Bakulin I.S., Sinitsyn D.O., Poydasheva A.G., Chernyavskiy A.Y., Suponeva N.A., Zakharova M.N., Piradov M.A.

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