Brain Topography

, Volume 24, Issue 1, pp 54–64 | Cite as

Neuronavigation Increases the Physiologic and Behavioral Effects of Low-Frequency rTMS of Primary Motor Cortex in Healthy Subjects

  • S. Bashir
  • D. Edwards
  • A. Pascual-LeoneEmail author
Original Paper


Low-frequency repetitive transcranial magnetic stimulation (rTMS) can exert local and inter-hemispheric neuromodulatory effects on cortical excitability. These physiologic effects can translate into changes in motor behavior, and may offer valuable therapeutic interventions in recovery from stroke. Neuronavigated TMS can maximize accurate and consistent targeting of a given cortical region, but is a lot more involved that conventional TMS. We aimed to assess whether neuronavigation enhances the physiologic and behavioral effects of low-frequency rTMS. Ten healthy subjects underwent two experimental sessions during which they received 1600 pulses of either navigated or non-navigated 1 Hz rTMS at 90% of the resting motor threshold (RMT) intensity over the motor cortical representation for left first dorsal interosseous (FDI) muscle. We compared the effects of navigated and non-navigated rTMS on motor-evoked potentials (MEPs) to single-pulse TMS, intracortical inhibition (ICI) and intracortical facilitation (ICF) by paired-pulse TMS, and performance in various behavioral tasks (index finger tapping, simple reaction time and grip strength tasks). Following navigated rTMS, the amplitude of MEPs elicited from the contralateral (unstimulated) motor cortex was significantly increased, and was associated with an increase in ICF and a trend to decrease in ICI. In contrast, non-navigated rTMS elicited nonsignificant changes, most prominently ipsilateral to rTMS. Behaviorally, navigated rTMS significantly improved reaction time RT and pinch force with the hand ipsilateral to stimulation. Non-navigated rTMS lead to similar behavioral trends, although the effects did not reach significance. In summary, navigated rTMS leads to more robust modulation of the contralateral (unstimulated) hemisphere resulting in physiologic and behavioral effects. Our findings highlight the spatial specificity of inter-hemispheric TMS effects, illustrate the superiority of navigated rTMS for certain applications, and have implications for therapeutic applications of rTMS.


Transcranial magnetic stimulation Navigated brain stimulation Motor cortex Cortical excitability Motor-evoked potentials Silent period and paired-pulse stimulation 



Work on this study was supported by grants from the National Center for Research Resources: Harvard-Thorndike General Clinical Research Center at BIDMC (NCRR MO1 RR01032) and Harvard Clinical and Translational Science Center (UL1 RR025758); NIH grant K24 RR018875 and a grant from the Nancy Lurie Marks Family Foundation to A.P.-L. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the Nancy Lurie Marks Family Foundation, National Center for Research Resources or the National Institutes of Health. The authors would like to thank Jari Karhu* valuable comments on a preliminary draft of the present manuscript, Jarmo Laine** and Tuomas Neuvonen** for technical support and Andrea Vatulas and Mark Thivierge for their administrative help. * Jari Karhu is employed part-time as professor in the Faculty of Medicine at the University of Kuopio and part-time as Chief Medical Officer of Nexstim Ltd. ** Jarmo Laine and Tuomas Neuvonen are employees for Nexstim Ltd.


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  2. 2.Burke-Cornell Medical Research InstituteWhite PlainsUSA
  3. 3.Centre for Neuromuscular and Neurological DisordersUniversity of Western AustraliaCrawleyAustralia
  4. 4.Institute Guttmann de NeurorrehabilitaciónUniversidad Autónoma de BarcelonaBarcelonaSpain

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