ArticleActa neurochirurgica2025
Resting motor threshold in navigated transcranial magnetic stimulation: relationship between inter-individual variance and distinct clinical and anatomical factors.
Article in Acta neurochirurgica, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Quantitative Navigated Transcranial Magnetic Stimulation Motor Mapping and nTMS-Guided Corticospinal Tractography in Healthy Individuals and Patients with Motor-Eloquent Brain Tumors.Brain sciences · 2026Article
- Mills-Nithi algorithm for navigated transcranial magnetic stimulation motor mapping in healthy subjects and brain tumor patients.Clinical neurophysiology practice · 2026Article
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8 authors.
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Abstract
backgroundNavigated transcranial magnetic stimulation (nTMS) is increasingly used in neurosurgical practice for preoperative motor mapping. The resting motor threshold (RMT), a measure of cortical excitability, has been linked to postoperative motor outcomes. However, RMT is influenced by many inter-individual factors, potentially limiting its interpretability. This study aimed to assess the influence of clinical and anatomical variables on RMT variability in neurosurgical patients.
methodsA total of 642 patients with motor-eloquent brain lesions underwent preoperative nTMS, yielding 1,193 bilateral RMT observations. Variables included age, sex, tumor volume, peritumoral edema, tumor side, skull-to-cortex distance (SCD), recurrence, motor deficits, tumor dominance, handedness, histology, anatomical location, and use of anticonvulsants, benzodiazepines, corticosteroids, or antidepressants. Linear mixed models were applied.
resultsRMT showed substantial inter-individual variability (mean 34 ± 8%, range 15-86%). Higher RMT included smaller peritumoral edema (estimate: -0.01; 95% CI: -0.03, -0.001; p = 0.032), greater SCD (estimate: 0.85; 95% CI: 0.63, 1.09; p < 0.001) and presence of motor deficits (estimate: 2.26; 95% CI: 0.89, 3.64; p = 0.001). Tumors outside the central region were associated with lower RMT (estimate: -1.87; 95% CI: -3.26, -0.47; p = 0.010). Medication analysis revealed that carbamazepine (estimate: 3.82; 95% CI: 0.81, 6.87; p = 0.014), benzodiazepines (estimate: 3.45; 95% CI: 1.11, 5.78; p = 0.004), and corticosteroids increased RMT (estimate: 1.56; 95% CI: 0.03, 3.09; p = 0.049), whereas antidepressants decreased it (estimate: -3.24; 95% CI: -5.90, -0.58; p = 0.019). Other factors showed no statistically significant effect.
conclusionThis study modeled the influence of clinical and anatomical factors on corticospinal excitability. This highlights the need for consideration of these variables when interpreting intervention-related changes in RMT or for risk stratification. Notably, the detailed analysis of common neurosurgical medications on RMT is unprecedented, emphasizing the importance of considering these factors.
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