Evidence map›Paper›PMID 42701450›Full record

ArticleClinical neurophysiology practice2026

Mills-Nithi algorithm for navigated transcranial magnetic stimulation motor mapping in healthy subjects and brain tumor patients.

Evangelia Chatzikyriakou, Ioannis Vlachos, Konstantinos Pastiadis, Nikolaos Foroglou, Konstantinos Kouskouras, Georgios Feretos, Christos Frantzidis, Ioannis Patsalas, Vasilios Papaliagkas, Dimitris Kugiumtzis and 1 more

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Article in Clinical neurophysiology practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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4 · The record

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5 · Who and what money

Authors and funding

11 authors.

Evangelia Chatzikyriakou1st Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece.
Ioannis Vlachos1st Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece.
Konstantinos PastiadisSchool of Music Studies, Aristotle University of Thessaloniki, Thessaloniki 57001, Greece.
Nikolaos ForoglouDepartment of Neurosurgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece.
Konstantinos KouskourasDepartment of Radiology, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece.
Georgios FeretosDepartment of Neurosurgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece.
Christos FrantzidisSchool of Engineering and Physical Sciences, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, UK.
Ioannis PatsalasDepartment of Neurosurgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece.
Vasilios PapaliagkasDepartment of Biomedical Sciences, International Hellenic University, Thessaloniki 57001, Greece.
Dimitris KugiumtzisDepartment of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.
Vasilios K Kimiskidis1st Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Objective: Navigated TMS (nTMS) motor mapping is typically performed at a fixed percentage of the resting motor threshold (rMT), most commonly 110%. The Mills-Nithi algorithm's upper threshold (UT), the minimal stimulation intensity evoking MEPs with 100% probability, has been proposed as an alternative. This study compared motor mapping at 110% rMT with the Mills-Nithi method in healthy subjects and patients with brain tumors. Methods: 11 healthy controls and 14 patients with supratentorial tumors underwent FDI motor mapping using both UT of the Mills-Nithi algorithm, and 110% rMT estimated with an adaptive threshold-hunting algorithm. Outcomes included the number of pulses, hotspot localization, map area, volume, centers of gravity, and DTI parameters (i.e., fiber count, FA, ADC, fiber length). Personalized sigmoid curves were fitted to estimate response probabilities. An independent control group of 12 healthy subjects underwent two nTMS mapping sessions at 110% rMT to establish baseline Earth Movers Distance (EMD) values. Results: Motor map characteristics and DTI metrics did not differ significantly between methods in either group. In healthy subjects, UT-based motor mapping required fewer stimuli than 110% rMT (110%: 256 ± 95 stimuli; UT: 227 ± 97; Conclusions: Motor mapping based on UT produces results comparable to 110% rMT, while improving procedural efficiency and response consistency in healthy subjects. Significance: Our findings support the Mills-Nithi algorithm as a practical alternative for clinical nTMS motor mapping.

Indexed as

Adaptive threshold-hunting algorithmMills-Nithi methodMotor mappingNavigated transcranial magnetic stimulation (nTMS)N TMS-DTI motor maps

Identifiers

PMID42701450
PMCPMC13545388

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.