Kaczmarczyk, I. | bioRxiv Science

bioRxiv2020

Comparison between conventional electrodes and ultrasound monitoring to measure TMS evoked muscle contraction

BackgroundTranscranial Magnetic stimulation (TMS) is a non-invasive cortical stimulation method that has been widely employed to explore cortical physiology in health and a range of diseases. At the core of many TMS protocols is the measurement of evoked muscle contractions using surface electromyography (sEMG). While sEMG is appropriate for many superficial muscles such as abductor pollicis brevis (ABP) and first dorsal interosseous (FDI), there are situations where the study of less accessible muscles may be of interest. Peripheral ultrasound is a non-invasive method that could provide a solution. We explore the relationship between TMS evoked sMEP and TMS evoked muscle contractions measured with muscle ultrasound. We hypothesise that in a healthy population, we expect a positive correlation between EMG and ultrasound measures. MethodsIn 10 participants we performed a standard TMS recruitment curve and simultaneously measured MEP and peripheral muscle ultrasound (pUS). We targeted the following muscles: biceps (BI), first dorsal interosseous (FDI), tibialis anterior (TA) and the tongue (TO). ResultsWe report a very close relationship between the MEP and pUS contraction. Resting motor threshold (RMT) measurements and recruitment curves are consistent in sEMG and pUS. A key aspect of this work is the ability to examine clinically relevant muscles that are difficult to probe using surface EMG electrodes, such as the tongue. ConclusionWe find that TMS muscle contractions can be measured with muscle ultrasound in superficial and deep muscles, enable additional, previously hard to study muscles, to be investigated. This could be valuable for allowing TMS to be used to explore a new range of muscles in disorders such as ALS. In muscles less accessible by sEMG, such as the tongue, it may be possible to use pUS as an alternative output. This may be useful in conditions such as ALS and stroke that can differentially affect the tongue.

neuroscience↗

bioRxiv2019

Short interval intracortical inhibition as measured by TMS-EEG

The diagnosis of amyotrophic lateral sclerosis (ALS) relies on involvement of both upper (UMN) lower motor neurons (LMN). Yet, there remains no objective marker of UMN involvement, limiting early diagnosis of ALS. This study establishes whether TMS combined with EEG can be used to measure short-interval intracortical inhibition (SICI) via TMS evoked potentials (TEP) in healthy volunteers - an essential first step in developing an independent marker of UMN involvement in ALS.\n\nWe hypothesised that a SICI paradigm would result in characteristic changes in the TMS-evoked EEG potentials that directly mirror the changes in MEP.\n\nTMS was delivered to the left motor cortex using single-pulse and three inhibitory stimulation paradigms. SICI was present in all three conditions. TEP peaks were reduced predominantly under the SICI 70 protocol but less so for SICI 80 and not at all for SICI 90. There was a significant negative correlation between MEPs and N45 TEP peak for SICI 70 (rho = -0.54, p = 0.04). In other words, as MEPs becomes inhibited the N45 increases. The same trend was maintained across SICI 80 and 90 (SICI 80, rho = -0.5, p = 0.06; SICI 90, rho = -0.48, p = 0.07). Additional experiments suggest these results cannot be explained by artefact.\n\nWe establish that motor cortical inhibition can be measured during a SICI 70 protocol expanding on previous work. We have carefully considered the role of artefact in TEPs and have taken a number of steps to show that artefact cannot explain these results and we suggesting the differences are cortical in origin. TMS-EEG has potential to aid early diagnosis and to further understand central and peripheral pathophysiology in MND.

neuroscience↗