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Neurology 2000;54:956-963
© 2000 American Academy of Neurology
Articles

Lasting cortical activation after repetitive TMS of the motor cortex

A glucose metabolic study H. R. Siebner, MD, M. Peller, BA, F. Willoch, MD, S. Minoshima, MD, PhD, H. Boecker, MD, C. Auer, MD, A. Drzezga, MD, B. Conrad, MD and P. Bartenstein, MD

From the Departments of Neurology (Drs. Siebner, Boecker, Auer, and Conrad, and M. Peller) and Nuclear Medicine (Drs. Willoch, Drzezga, and Bartenstein), Technische Universität München, Munich, Germany; and the Division of Nuclear Medicine (Dr. Minoshima), Department of Internal Medicine, the University of Michigan Medical Center, Ann Arbor, MI.

Address correspondence and reprint requests to Dr. Hartwig Roman Siebner, Neurologische Klinik und Poliklinik, Technische Universität MünchenMoehlstrasse 28, 81675 Munich, Germany; e-mail: hartwig.siebner{at}neuro.med.tu-muenchen.de

OBJECTIVE: Cerebral [18F]fluorodeoxy-D-glucose PET ([18F]FDG-PET) was used to visualize the lasting neuronal activation after repetitive transcranial magnetic stimulation (rTMS) over the left hand area of the primary motor cortex (M1HAND).

BACKGROUND: Applied over M1HAND, rTMS has been shown to produce a modulation of corticomotor excitability beyond the time of stimulation itself.

METHODS: Eight right-handed subjects underwent nonquantitative [18F]FDG-PET measurements during two experimental conditions: at rest and after focal subthreshold 5-Hz rTMS over the left M1HAND. In the post-rTMS condition, [18F]FDG was injected immediately after the administration of 1,800 magnetic pulses over the left M1HAND. Relative differences in normalized regional cerebral metabolic rate of glucose (normalized rCMRglc) between conditions were determined using a voxel-by-voxel Student’s t-test and volume-of-interest (VOI) analysis. Analysis was a priori restricted to the M1HAND, the supplementary motor area (SMA), and the primary auditory cortex of both hemispheres.

RESULTS: A 5-Hz rTMS of the left M1HAND caused a lasting relative increase in normalized rCMRglc within the M1HAND bilaterally and the SMA. The magnitude and the topographic pattern of persisting relative rCMRglc increases within these motor cortical areas demonstrated considerable interindividual variations.

CONCLUSIONS: Subthreshold 5-Hz repetitive transcranial magnetic stimulation (rTMS) over the hand area of the primary motor cortex is associated with a persisting neuronal activation in a distinct set of motor cortical areas beyond the time of stimulation. The current findings demonstrate that [18F]FDG-PET can localize and quantify regional net changes in synaptic cortical activity after rTMS and thus might elucidate the mechanisms underlying rTMS-associated therapeutic effects.

Key words: Brain activation—Primary motor cortex—Supplementary motor area—Positron emission tomography—Regional cerebral glucose metabolism—Repetitive transcranial magnetic stimulation




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