J G Grab1, E Zewdie2, H L Carlson3, H-C Kuo4, P Ciechanski5, J Hodge6, A Giuffre7, A Kirton8. 1. Calgary Pediatric Stroke Program, Alberta Children's Hospital, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada. Electronic address: Jeff.Grab@ahs.ca. 2. Calgary Pediatric Stroke Program, Alberta Children's Hospital, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada. Electronic address: Ephrem.Zewdie@albertahealthservices.ca. 3. Calgary Pediatric Stroke Program, Alberta Children's Hospital, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada. Electronic address: Helen.Carlson@albertahealthservices.ca. 4. Calgary Pediatric Stroke Program, Alberta Children's Hospital, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada. Electronic address: HsingChing.Kuo@albertahealthservices.ca. 5. Calgary Pediatric Stroke Program, Alberta Children's Hospital, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada. Electronic address: Patrick.Ciechanski@albertahealthservices.ca. 6. Calgary Pediatric Stroke Program, Alberta Children's Hospital, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada. Electronic address: Jacquie.Hodge@albertahealthservices.ca. 7. Calgary Pediatric Stroke Program, Alberta Children's Hospital, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada. Electronic address: Adrianna.Giuffre@albertahealthservices.ca. 8. Calgary Pediatric Stroke Program, Alberta Children's Hospital, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada. Electronic address: Adam.Kirton@albertahealthservices.ca.
Abstract
BACKGROUND: The human motor cortex can be mapped safely and painlessly with transcranial magnetic stimulation (TMS) to explore neurophysiology in health and disease. Human error likely contributes to heterogeneity of such TMS measures. Here, we aimed to use recently pioneered robotic TMS technology to develop an efficient, reproducible protocol to characterize cortical motor maps in a pediatric population. NEW METHOD: Magnetic resonance imaging was performed on 12 typically developing children and brain reconstructions were paired with the robotic TMS system. The system automatically aligned the TMS coil to target sites in 3 dimensions with near-perfect coil orientation and real-time head motion correction. Motor maps of 4 forelimb muscles were derived bilaterally by delivering single-pulse TMS at predefined, uniformly spaced trajectories across a 10 × 10 grid (7 mm spacing) customized to the participant's MRI. RESULTS: Procedures were well tolerated with no adverse events. Two male, eight-year-old participants had high resting motor thresholds that precluded mapping. The mean hotspot coordinate and centre of gravity coordinate were determined in each hemisphere for four forelimb muscles bilaterally. Average mapping time was 14.25 min per hemisphere. COMPARISON WITH EXISTING METHODS: Traditional manual TMS methods of motor mapping are time intensive, technically challenging, prone to human error, and arduous for use in pediatrics. This novel TMS robot approach facilitates improved efficiency, tolerability, and precision in derived, high-fidelity motor maps. CONCLUSIONS: Robotic TMS opens new avenues to explore motor map neurophysiology and its influence on developmental plasticity and therapeutic neuromodulation. Our findings provide evidence that TMS robotic motor mapping is feasible in young participants.
BACKGROUND: The human motor cortex can be mapped safely and painlessly with transcranial magnetic stimulation (TMS) to explore neurophysiology in health and disease. Human error likely contributes to heterogeneity of such TMS measures. Here, we aimed to use recently pioneered robotic TMS technology to develop an efficient, reproducible protocol to characterize cortical motor maps in a pediatric population. NEW METHOD: Magnetic resonance imaging was performed on 12 typically developing children and brain reconstructions were paired with the robotic TMS system. The system automatically aligned the TMS coil to target sites in 3 dimensions with near-perfect coil orientation and real-time head motion correction. Motor maps of 4 forelimb muscles were derived bilaterally by delivering single-pulse TMS at predefined, uniformly spaced trajectories across a 10 × 10 grid (7 mm spacing) customized to the participant's MRI. RESULTS: Procedures were well tolerated with no adverse events. Two male, eight-year-old participants had high resting motor thresholds that precluded mapping. The mean hotspot coordinate and centre of gravity coordinate were determined in each hemisphere for four forelimb muscles bilaterally. Average mapping time was 14.25 min per hemisphere. COMPARISON WITH EXISTING METHODS: Traditional manual TMS methods of motor mapping are time intensive, technically challenging, prone to human error, and arduous for use in pediatrics. This novel TMS robot approach facilitates improved efficiency, tolerability, and precision in derived, high-fidelity motor maps. CONCLUSIONS: Robotic TMS opens new avenues to explore motor map neurophysiology and its influence on developmental plasticity and therapeutic neuromodulation. Our findings provide evidence that TMS robotic motor mapping is feasible in young participants.
Authors: Adrianna Giuffre; Ephrem Zewdie; Helen L Carlson; James G Wrightson; Hsing-Ching Kuo; Lauran Cole; Adam Kirton Journal: Physiol Rep Date: 2021-04
Authors: Cynthia K Kahl; Rose Swansburg; Tasmia Hai; James G Wrightson; Tiffany Bell; Jean-François Lemay; Adam Kirton; Frank P MacMaster Journal: J Psychiatry Neurosci Date: 2022-07-06 Impact factor: 5.699
Authors: Cynthia K Kahl; Adrianna Giuffre; James G Wrightson; Adam Kirton; Elizabeth G Condliffe; Frank P MacMaster; Ephrem Zewdie Journal: Physiol Rep Date: 2022-06
Authors: Hsing-Ching Kuo; Ephrem Zewdie; Adrianna Giuffre; Liu Shi Gan; Helen L Carlson; James Wrightson; Adam Kirton Journal: Hum Brain Mapp Date: 2022-04-22 Impact factor: 5.399
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Authors: Cynthia K Kahl; Rose Swansburg; Adam Kirton; Tamara Pringsheim; Gabrielle Wilcox; Ephrem Zewdie; Ashley Harris; Paul E Croarkin; Alberto Nettel-Aguirre; Sneha Chenji; Frank P MacMaster Journal: BMJ Open Date: 2021-12-24 Impact factor: 2.692